Sushant Singh Rajput. Photo: PTI.

Trigger warning: Suicide

In September 2016, Susan Schneider Williams published a heart-wrenching personal account of her husband, actor Robin Williams, and his battle against diffuse Lewy body disease. This disease is a progressive neurological illness that adversely affects the patient’s physical and mental health. The article was published in a peer-reviewed journal, Neurology, and detailed the late actor’s health decline and eventual death by suicide on August 11, 2014.

His wife disclosed details about his mental health status and treatment in an effort to humanise the illness and its debilitating mental health consequences. It was a conscious choice made by a close relative of a deceased individual with a clear, constructive purpose: to combat stigma and raise awareness.

In contrast, the Indian media’s coverage of Sushant Singh Rajput’s death by suicide on June 14, 2020, has been one big lesson on how not to report on issues of mental health and suicide. Unconfirmed, confidential details regarding the late actor’s alleged mental health diagnoses have been preyed on and paraded about in a shockingly voyeuristic manner since his demise. These self-serving acts are in complete subversion of the law and professional ethics.

In their code of conduct, the Indian Association of Clinical Psychologists denounces the disclosure of patient information to anyone other than concerned co-professionals or any appropriate authorities. This strict view of confidentiality applies to the work of healthcare professionals around the world. It is also included in the Hippocratic oath and the Declaration of Geneva. The fundamental principle is clear: healthcare providers have a strong ethical obligation to keep the patient’s confidence when discharging their professional duties.

Confidentiality in healthcare is the very foundation on which a trusting therapeutic relationship is built. Without an implicit understanding that their disclosures will be kept private, patients are liable to withhold information that may be key to the planning and provision of their care.

This is particularly relevant to mental health care, where an assurance of confidentiality can be an incentive for seeking professional support. In India, significant demand-side barriers for mental health are due to pervasive stigma and limited awareness about mental health issues. However, there is a fine line between destigmatising mental health issues and breaching patient confidentiality when one can no longer consent to it.

The principle of confidentiality also respects the autonomy of a competent patient by defending their right to decide how their private information is used and shared. India doesn’t yet have a personal data protection Act. However, the Supreme Court has deemed the right to privacy to be fundamental, protected by the Constitution. The proposed Personal Data Protection Bill 2019 explicitly seeks to protect health data under the ‘sensitive personal data’ category.

There is a clear legal obligation for healthcare providers in India to maintain strict confidentiality about any aspect of their patient’s mental illness. Chapter V of the Mental Health Care Act (MHCA) 2017 specifies the various rights a person with mental illness has. Section 23 addresses the right to confidentiality, which unequivocally serves to safeguard the right of individuals to their mental health status, care and treatment.

The exceptions to this provision are also clear. Other healthcare professionals who are also involved in administering care may be privy to such information as required. Only such information that’s necessary to protect against harm, threats to life and which are in the interest of public safety may be released – and only after a statutory authority, like a high court or the Supreme Court, orders it.

The only other exception to the right to confidentiality is disclosure to a nominated representative. This is an individual appointed by an advance directive under Chapter IV of the MHCA 2017, and must be a relative, caregiver or any person deemed suitable by a State Mental Health Review Board.

In Rajput’s case, the release of confidential information regarding his alleged mental health status and treatment don’t qualify for any of these exceptions outlined in the Act. We also currently don’t know if Rajput established an advance directive granting a nominated representative access to sensitive, personal information.

Why then were these details released to various media professionals and publications, rendering them widely accessible? And can we truly verify that this information is accurate? If not, it has no business being in the public domain.

Often, professional judgment and experience will dictate whether a breach of confidentiality is warranted – but it’s highly risky in a country where the mental healthcare provision is alarmingly unregulated.

For example, an individual who claimed to be ‘treating’ Rajput in the capacity of a clinical psychologist publicly revealed details of Rajput’s apparent diagnosis to a journalist. The Rehabilitation Council of India register doesn’t provide licensing information for this professional, which suggests they may not be registered to legally practice in India. This makes their disclosure of Rajput’s unsubstantiated personal data to the media both unethical and unlawful. However, the enforcement of a legal duty for data protection in Indian law leaves much to be desired.

The mishandling of Rajput’s purported medical records also doesn’t seem by any means to have been inadvertent. Instead, it appears to be a deliberate, persistent and targeted act that has far-reaching political, social and public health consequences. To overlook or rationalise these actions as anything but gross professional misconduct is a huge disservice to the tireless efforts of activists working to destigmatise mental health issues in India.

Importantly, public curiosity is no justification for breach of confidentiality, irrespective of whether the individual lived and worked in the public eye. We do need to draw the line between what is in the public interest and what the public is interested in.The detection or prevention of a serious crime would be in the public interest. While one could argue that the circumstances surrounding Rajput’s suicide are mired in controversy, and the case is currently being probed by the Central Bureau of Investigation, Rajput is not on trial here. So publicly disclosing sensitive details about his health violates his right to privacy when he can no longer defend it.

If the law required disclosure of certain information, it wouldn’t amount to a breach, but only a statutory authority  can legally demand disclosure in the first place. When the media is granted unfettered access to unethical mental health professionals, we end up with clickbait and sensationalism. This can only harm the cause of improving mental health access in India.

Author’s note: If you’re a media professional or writer interested in mental health reporting, you can sign up for a free workshop on ‘Reporting Suicides Responsibly’, in accordance with WHO guidelines. The Centre for Mental Health Law & Policy is conducting it, with Dr Soumitra Pathare in the lead. Register here.

Shruti Raghuraman is a doctoral researcher in clinical psychology at the University of Nottingham. Her current research focuses on psychological trauma and recovery. She’s interested in making affordable mental health education and services available and accessible in low-resource contexts.