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Self-harm confidentiality — DCH MCQ

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HardEthics and communicationSelf-harm confidentialityDCH

A 13-year-old presents after disclosing self-harm. In private, she demonstrates sufficient maturity and understanding to make decisions about information sharing. She refuses parental involvement, and there is no suggestion that involving her parents would itself place her at risk. Which additional finding most clearly justifies sharing the minimum necessary information without her consent to protect her?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Current intent to die, a specific plan, and immediate access to the means

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

B is correct. Current intent to die combined with a specific plan and immediate access to the means indicates a risk of death or serious harm. Necessary and proportionate information should therefore be shared with appropriate people or services despite her refusal, while explaining the decision and involving her as far as possible. Competence and a request for confidentiality remain important but do not prevent disclosure needed to protect a child from serious harm. Superficial non-suicidal self-injury, passive thoughts, cyberbullying and low mood all require careful psychosocial assessment and safety planning, but none alone establishes the same immediate justification for disclosure. Parental involvement is not automatic if it could increase risk; only the minimum necessary information should be shared with appropriate recipients.

Reference: NHS England, Staying safe from suicide: Information sharing and involving others; Confidentiality and the law, updated 11 June 2025. https://www.england.nhs.uk/long-read/staying-safe-from-suicide/