Concern of Client Safety/Welfare

Re: Concern of Client Safety/Welfare

Hannah Wynne Richards — Wed, 25 Sep 2013 15:50:00 GMT

I'm not one to routinely abuse Royal College-normally I'm suppertive of them, but the issue of reporting is one where they are amazingly and woryingly inconsistent.

The first time I seriously questioned their "wisdom" was when they categorically forbade us from reporting owners whose dogs had been involved with either organised dog foghting, or badger baiting, to the police.

I then welcomed the decision (in 2003-they might have been trying to regain the moral high ground after the profession at large showed itself to be far more ethical than RCVS on the subject of feline kidney transplants) that we had a duty to report non-accidental injury.

Now, they seem to be going back to the" professional confidentiality is sacrosanct" viewpoint. Gossip is (obviously) totally wrong, but there are occasions when keeping quet is morally wrong

Wynne

Re: Concern of Client Safety/Welfare

Martin Atkinson — Wed, 25 Sep 2013 11:29:28 GMT

[quote user="Hannah Bose"]

Have you every considered working for the Samaritans, Martin? Sounds like you would fit in. Did you know that they are not allowed (by their own guidelines*) to tell someone not to commit suicide? Now that's a sad state of affairs.

* source = my dad, trained Samaritan

[/quote] Clearly laced with sarcasm Hannah but you are right, I would listen to everyone's problems and although I may suggest alternative solutions I would not betray their trust

Re: Concern of Client Safety/Welfare

Bob Russell — Wed, 25 Sep 2013 11:20:47 GMT

[quote user="tess"]

I don't know if any of you were at the talk on domestic violence at the London Vet Show last year, but the RCVS line was they couldn't guarantee that action wouldn't be taken against us for breaking client confidentiality in those situations (pretty appalling in my opinion). Presumably the same is true where there is a potential suicide issue.

VDS did say they would be happy to advise with a DV situation, so I guess they would with the suicide situation as well.

[/quote]

If this was their attitude it says it all with regard to the RCVS. If you broadcast to all and sundry perhaps as it could be seen as bringing the profession into disrepute. It could be argued that with DV involving an animal patient, you are acting in a professional role. I doubt the RCVS would be much more use than a chocolate teapot should you ask a straight question, expecting a straight answer.

Otherwise you are a concerned member of the general public expressing concern.

Re: Concern of Client Safety/Welfare

tess — Tue, 24 Sep 2013 22:00:23 GMT

VDS did say they would be happy to advise with a DV situation, so I guess they would with the suicide situation as well.

Re: Concern of Client Safety/Welfare

Bob Russell — Tue, 24 Sep 2013 17:42:03 GMT

[quote user="mariette asselbergs"]

Samaritans do not give people ANY advise, they only listen. They are not a helpline for info or advise or referrals, they only let people talk.

Mariette

[/quote]

Actually they guide people to get them to talk, perhaps a subtle difference but it can make a world of difference! This can work wonders!

A good councillor will get you to talk and guide you to make your own decisions and support you as you get there.

Samaritans do a great job for the crisis periods and do a lot more than just let you talk. What they don't do is give advice or suggest answers!

Re: Concern of Client Safety/Welfare

mariette asselbergs — Tue, 24 Sep 2013 14:50:59 GMT

Samaritans do not give people ANY advise, they only listen. They are not a helpline for info or advise or referrals, they only let people talk.

Mariette

Re: Concern of Client Safety/Welfare

HMC — Tue, 24 Sep 2013 14:36:07 GMT

* source = my dad, trained Samaritan

Re: Concern of Client Safety/Welfare

Julie Innes — Fri, 20 Sep 2013 19:11:29 GMT

Difficult one. In the past I've had a couple of clients I have been worried about after the death of a spouse/ animal. I must admit I have been known to drop in to see them/ give them a call on some spurious excuse a ffew times, although I know that isn't really the answer. I did once contact social services about a client living alone who was desperately confused. How sad that as a society people can feel so isolated. I probably get too involved with my clients, but it's just the way I am and I like it that way.

Re: Concern of Client Safety/Welfare

Bob Russell — Fri, 20 Sep 2013 17:01:52 GMT

Grieving is normal and is a really tough thing to go through. It is a normal part of how we are wired up. Some of us cope well, some cope really badly. Most get through with time and friends/family support, some need a lot more help.

The best definition of acute mental illness I could find was:

"Acute Mental Illness

Acute mental illness is characterised by significant and distressing symptoms of a mental illness requiring immediate treatment. This may be the person's first experience of mental illness, a repeat episode or the worsening of symptoms of an often continuing mental illness. The onset is sudden or rapid and the symptoms usually respond to treatment."

If a grieving person is genuinely suicidal I think the term applies.

I would hope someone would care enough about a member of my family to take action if they felt he or she was at risk. We are talking about an intelligent, professional person observing worrying signs in a client.

I would consider a duty to pass on my concerns to someone who has the knowledge to assess the person. I am not qualified to do more nor would I feel obliged to.

Re: Concern of Client Safety/Welfare

Martin Atkinson — Fri, 20 Sep 2013 16:59:39 GMT

[quote user="Virginia Campbell"]What on earth has her age got to do with anything? Would you act differently if she was 35, 71 or 86?[/quote] My point here was not so much their age but if they were very old it is more likely that they may have ongoing medical problems themselves and didn't wish to face the future with those. My daughter was caught between 2 stones in the case of her friend, she didn't want to betray her friend's trust but was then wracked with guilt that she didn't do anything about it. Its a no win situation. In the case of the woman in the OP it is unlikely that the vet is the only person who is aware of her mental state and as I said before there are usually close friends and relatives who are in a better position to help. If she doesn't have any of those then maybe her life isn't worth living. It is up to the individual's conscience to decide whether or not to intervene neither is right or wrong, you also have to live with the consequences of your action or inaction. If I was vet in the OP I would feel that someone had confided in me and I would choose not to betray that trust, and know I could live with the consequences. I don't think that makes me a better or worse person than the one who chooses the opposite course of action. However if it was my close friend or relative I would move heaven and earth to help stop them. Does that make me a hypocrite or just dealing with my responsibility in a different way?

Re: Concern of Client Safety/Welfare

mariette asselbergs — Fri, 20 Sep 2013 15:48:52 GMT

Bob, this sounds to me like a normal human reaction to a distressing event which happens to everybody several times in their lives. Bereavement and sadness is no acute mental illness!

It also sounds to me as a sound reaction to the realisation that sudden death leaves things disorganised with sometimes awful consequences. It is therefor totally understandable that the lady in question decides to make sure that things are all in order in case a similar thing happens to her. That does not mean she is necessarily planning to end her life, just that she has become aware that life is fragile and you can prepare better. If your surroundings then interpret her behaviour as mental illness or suicidal that seems almost insulting to me and definitely interfering from outsiders like her vet, who she involved in making sure things are safe for her pets if anything happens.

Of course I may be wrong. I don't know the relationships involved.

Mariette

Re: Concern of Client Safety/Welfare

Bob Russell — Fri, 20 Sep 2013 10:33:23 GMT

If someone has made a decision to commit suicide in the cold light of day, clear headed and not suffering for depression then it is their choice. I am far from against the right to end our own lives under humane and controlled conditions.

This person has put you in the situation by behaving in this way. I would suspect depression is involved.

If this client is intent on suicide it will happen whatever you do. If it is due to acute mental illness she needs help!

Re: Concern of Client Safety/Welfare

Virginia Campbell — Fri, 20 Sep 2013 10:27:09 GMT

[quote user="Martin Atkinson"] a sound state of mind as this woman seems to be by her rational actions (we don't know her age so its difficult) [/quote]

What on earth has her age got to do with anything? Would you act differently if she was 35, 71 or 86?

Re: Concern of Client Safety/Welfare

Bibs — Fri, 20 Sep 2013 10:19:55 GMT

I don't think you can take the attitude that if someone has a salvagable life but makes a decision to try and commit suicide that you should leave them to it. People who survive such attempts often regret it and recover. To me hinting and telling someone you feel like that is a cry for help. In this case who knows what she really means but if you're seriously worried then you should do something. Probably talking to a local GP would be a good start as they can point you in the right direction. You are worried about a person's welfare which I think overrules any confidentiality issues. You don't even have to name names when getting professional advice initially do you? Maybe just case out if you should be worried or not.

Re: Concern of Client Safety/Welfare

Gillian Mostyn — Fri, 20 Sep 2013 09:47:27 GMT

As you say Martin, every situation is unique and you have obviously had a horrible experience following a suicide of someone who had a long battle with mental illness.

In this situation (of which we obviously know only a limited amount) it sounds like this lady may be clinically depressed following the death of a spouse. I would say that there is every chance her life would improve in time - but she is unlikely to be able to see past her devastating grief at the moment. I, like the OP,would find it difficult to ignore the situation.

Re: Concern of Client Safety/Welfare

Martin Atkinson — Fri, 20 Sep 2013 09:02:17 GMT

[quote user="Gillian Mostyn"]If someone came on here and said 'I've decided to end my life' would you really just say 'well it's your decision and you seem like a very sensible person.'? [/quote] In truth I'm not sure how I would react. If it was a relative or a close friend I'm sure I would make some attempt to intervene but I don't know how far down the line I would go. It comes to a point where someone wants to travel to Switzerland for euthanasia, would you stop them? This is some ways no different. Do you have a moral belief that suicide is wrong and a personal obligation to prevent it all costs or accept someone's wishes? My daughter's friend committed suicide some years ago, it was a high profile case that made the national news, she had pronounced on facebook that she was going to do it and my daughter felt guilty that she had done nothing to help to the point she became depressed and almost suicidal herself. This girl's parents knew she was mentally ill, she was receiving attention and I have to say that I believe that her home life and their relationship with her was in no small way a contributory factor. She had planned her suicide so meticulously she had left not just a note but a veritable dossier giving details of how she wanted her affairs to be dealt with even down to the order of service she wanted at her funeral. There was nothing that was going to stop this girl committing suicide yet my daughter was wracked with guilt that it was in some way her fault and is still affected no ten years on. I tried to change her guilt to a feeling of anger that this girl's actions should have left her feeling this way.In the case of the OP I still believe that I would do nothing other than just continue to lend a sympathetic ear.

Re: Concern of Client Safety/Welfare

Gillian Mostyn — Thu, 19 Sep 2013 23:32:18 GMT

[quote user="Robin Grimmer"]A good reason to keep relations with clients on a professional basis. I tend to avoid getting too involved with clients' personal problems, however traumatic they might be.[/quote]

I know what you mean, and it is generally best to avoid getting involved. However, some of our clients are very isolated and, by looking after their much loved pet over a significant length of time, they often develop a lot of trust and affection for us. Being able to help people during difficult periods of their life is something we should be proud of- not shy away from! It is nothing to do with being a good vet - it is about being a good human being!

Re: Concern of Client Safety/Welfare

Gillian Mostyn — Thu, 19 Sep 2013 23:27:46 GMT

Are you serious Martin?

If someone came on here and said 'I've decided to end my life' would you really just say 'well it's your decision and you seem like a very sensible person.'?

Personally I'd rather offer some help and be knocked back than stand back and do nothing when somebody is obviously in so much emotional pain and distress that dying seems like the best option. Tragic.

Re: Concern of Client Safety/Welfare

Robin Grimmer — Thu, 19 Sep 2013 23:26:51 GMT

[quote user="An On MRCVS"]

Anon so this can't be traced to my practice.

A client of ours recently lost her husband, he had terminal cancer but died much quicker than expected so it was quite a shock to her. Since her husband passed away she has been coming in with her dogs fairly often for chats. She seems quite upbeat, but things have changed in the past week or so.

She has been telling one of our nurses that she is struggling to cope, she has made arrangements with the Cinnamon Trust for her dogs to be cared for if she passes away suddenly. I helped her move a load of wood from a tree that had recently been cut down (free firewood, why not?) and at the same time she showed me round the house to show me where all the animal's things were, from leads/coats/food all the way to paperwork!

Part of me is thinking that it is just her being shocked in to being prepared, but some of our staff are worried she is seriously depressed, and her actions are pointing to something untoward happening. If we are worried, is there anyone, particularly authorities wise, we could speak to? Or does client confidentiality cover this?

[/quote]

A good reason to keep relations with clients on a professional basis. I tend to avoid getting too involved with clients' personal problems, however traumatic they might be.

Re: Concern of Client Safety/Welfare

Martin Atkinson — Thu, 19 Sep 2013 18:00:03 GMT

[quote user="Bob Russell"]Would you be happy if one of your parents committed suicide during one of these extreme stages in life and you knew someone might have managed to prevent it?[/quote] All I know is that if I was in a sound state of mind as this woman seems to be by her rational actions (we don't know her age so its difficult) and felt I had nothing to live for, I would like to be left in peace to make that decision myself. My mother died suddenly some years ago and my father who was totally dependent one her emotionally if not physically gave up the will to live even though he was basically in good nick for his 95 years, It was a blessed relief when he died almost literally from a broken heart as his life was clearly no longer worth living. There is no obvious cry for help here just someone to talk to and a clear path to sorting out her affairs before she goes whether by her own hand or from natural causes, she may be suffering from a serious medical condition herself which she may not be admitting to.

[quote user="Bob Russell"]I would rather have a live, disgruntled person than a dead one! [/quote] I would rather be one happy dead person than a unhappy, disgruntled living one.

Re: Concern of Client Safety/Welfare

Bob Russell — Thu, 19 Sep 2013 17:44:09 GMT

The whole purpose of contacting the GP is to allow someone with suitable knowledge to make a judgement on someones mental health. The decisions made under stress and understandable depression are not logical and a few weeks or months down the line it is very likely that person would be grateful.

Would you be happy if one of your parents committed suicide during one of these extreme stages in life and you knew someone might have managed to prevent it?

There are stages in life where you do not think clearly, require a lot of help to prevent yourself doing something that many around you will regret for the rest of their lives.

I would rather have a live, disgruntled person than a dead one!

Re: Concern of Client Safety/Welfare

Dagmar Steele — Thu, 19 Sep 2013 17:10:21 GMT

Yes and no. Many people have been in situations when they thought life wasn't worth living any more. I probably wouldn't be alive any more if things had gone a bit differently nearly twenty years ago. It would have been a pity though as I'm now a reasonably happy person with a family I love very much. People in emotional distress see things very negative but this might change over a couple of months with some help. If she still wants to commit suicide she'll do it anyway, but then she did have a helping hand to pull her out if she just needed that to be able to carry on! The fact that she kind of confides in someone is usually meant to be as a cry of help, those who are really convinced they want to leave this world do so without giving hints to anybody.

Re: Concern of Client Safety/Welfare

mariette asselbergs — Thu, 19 Sep 2013 16:59:46 GMT

Agree with you there Martin. If I were the woman I would be furious if somebody sent a GP, a social worker or the samaritains to me without talking to me first about what is only second guessing!

Mariette

Re: Concern of Client Safety/Welfare

Martin Atkinson — Thu, 19 Sep 2013 16:56:50 GMT

Am I the only one who believes that this woman has rationally thought this through and if she is considering suicide she be left to make that decision for herself. If she doesn't feel life is worth living why prolong her misery? Sorry if you all feel that is being callous but if anyone was in a position to help it may be better to be a friend or relative. I know that sometimes clients put their trust in us and spill out their hearts more than they may even to their family but that is because they feel they can trust us as caring people. Would telling someone else be a betrayal of that trust? A difficult call I'll admit.

Re: Concern of Client Safety/Welfare

Dagmar Steele — Thu, 19 Sep 2013 16:53:51 GMT

similar story: Old lady's dog had been run over by car, was dead on arrival. She told me she's not going to live any longer as this was the only living being she had in the world. Very excited and agitated so after trying to calm her down and failing I called an ambulance. She refused to go to hospital despite turning blue due to her heart condition but in the end she had some diazepam and then produced the contact details for her daughter who came to pick her up!