Draft letters to help caregivers communicate important information to clinicians.
When Privacy Is Misunderstood
Many caregivers are told, or come to believe, that privacy law prevents them from communicating with the physicians treating their adult loved one with serious mental illness. This is a common misunderstanding. Privacy legislation is intended primarily to protect patients by regulating what health-care providers may disclose—not by preventing caregivers from providing important information. Caregivers are entitled to share observations, concerns, and factual information that may assist in assessment, diagnosis, treatment, or safety planning. While a clinician may sometimes be unable to discuss confidential information in return, there is generally no barrier to receiving and considering information offered by a caregiver.
The sample letters in this section are designed to help families communicate clearly, respectfully, and effectively with clinicians when timely information may make a meaningful difference to patient care.
Suggestions for use of letter to clinician
Read the sample letters carefully. Decide which one best fits your situation and change as needed.
Include the physician’s full name and status at the top of the page.
The following are suggested signatures. Having more than one is beneficial:
parent who wrote the letter,
second parent (if applicable),
grandparent,
sibling and
spouse
Ensure that you request an acknowledgement of receipt from your clinician.
Send your letter by email with a copy sent by registered mail. This will help to ensure that your letter
is officially received and filed.
Prepare your follow-up collateral information (see Supporting Information on the website for samples).
Put a clear reference number on your letters in case you do not receive a reply or receive a disrespectful
or dismissive reply.
If you have a legal advisor, make sure to send a copy of your letter to the advisor (or, if you have funds,
get your legal advisor to send the letter on your behalf).
If you wish to add some legal advice, download, print and include this document in your letter. It explains what doctors are allowed and obliged to do. Download PDF
Written in the voice of a concerned mother — respectful but clear, highlighting both her son’s needs
and the legislative/clinical context.
[Mother’s Name]
[Address]
[City, Province, Postal Code]
[Phone Number]
[Email]
Date: [Insert Date]
Dr. [Physician’s Full Name]
[Clinic or Practice Name]
[Address]
Dear Dr. [Physician’s Last Name],
I am writing as the mother of my 25-year-old son, [Son’s First Name], who is currently under your care.
He lives with a severe mental illness and, as you may know, one of the most challenging symptoms he
experiences is anosognosia — a lack of awareness of his illness. This makes it extremely difficult for him
to recognize the seriousness of his condition or to ask for help.
Because of this, I am deeply concerned about some risky behaviors he has been engaging in recently.
These behaviors put his health and safety at risk, and without adequate communication between you as
his physician and me as his caregiver, I fear that he may not receive the support he needs to avoid the
most severe consequences.
I understand that privacy legislation has historically made professionals cautious about sharing information
with caregivers of adults. However, I also know that recent legislative and policy changes encourage healthcare
providers to involve families more readily, particularly in cases where the patient’s judgment is impaired by
the very nature of their illness. I respectfully ask you to consider these changes and to open a line of
communication with me.
Please understand that I am not asking for confidential medical details that you cannot legally disclose.
Rather, I am seeking guidance on how I can best support my son in his treatment and safety, and I am
offering to share important observations about his behaviors, routines, and challenges. My goal is to work
with you — as part of his care team — so that together we can give him the best chance at stability, safety,
and recovery.
I have always admired the dedication of family physicians in balancing patient autonomy with family involvement,
and I know how difficult these decisions can be. I believe that, in this case, cooperation between us could make
the difference between crisis and stability.
Thank you for taking the time to consider my request. I would be grateful for a call or meeting at your earliest
convenience.
[Mother’s Name]
[Address]
[City, Province, Postal Code]
[Phone Number]
[Email]
Date: [Insert Date]
Dr. [Physician’s Full Name]
[Clinic or Practice Name]
[Address]
Dear Dr. [Physician’s Last Name],
I am the mother of [Son’s First Name], a 25-year-old patient living with severe mental illness. A significant
symptom of his condition is anosognosia — a lack of awareness of his illness — which prevents him from seeking
or accepting care in a consistent or safe manner. This directly increases his risk of harm to himself.
I am aware that historically privacy legislation has discouraged professionals from sharing information with
caregivers once a patient is over the age of 18. However, a recent amendment to NS PHIA Clause 38(1)(d)
reads as follows:
38 (1) A custodian may disclose personal health information about an individual without the individual's consent
(d) to any person if the custodian believes, on reasonable grounds, that the disclosure will avert or minimize a
significant danger to the health or safety of any person or class of persons;
The intention of this amendment is to encourage providers to use clinical judgment in contacting caregivers when
it is in the patient’s best interests, especially where impaired insight prevents informed decision-making.
In line with this evolving standard of practice, I am respectfully requesting that you establish direct communication
with me. While I understand there may be limits on the sharing of confidential medical details, legislation does allow —
and in many cases encourages — the exchange of information necessary to protect health and safety, as well as the receipt
of information from family members that may guide clinical care.
I ask that you consider this not only as a legal allowance but as a moral imperative. Without timely collaboration between
physicians and families, patients like my son too often fall through the cracks, with consequences that can include
hospitalization, homelessness, or suicide.
Please let me know when we can arrange a discussion. I am committed to supporting your clinical role and ensuring that my
son receives safe, appropriate care.
Personal / emotional version (heartfelt, less formal).
[Mother’s Name]
[Address]
[City, Province, Postal Code]
[Phone Number]
[Email]
Date: [Insert Date]
Dr. [Physician’s Last Name],
I am reaching out as a mother who is deeply worried about her 25-year-old son, [Son’s First Name]. He has a severe mental
illness, and one of the hardest parts is that he doesn’t realize how ill he is. This lack of awareness — the doctors call it
anosognosia — means he often refuses help, even when he desperately needs it.
Lately he has been engaging in risky behaviors that frighten me. I see warning signs every day, and I am afraid that without
stronger communication between us, he may come to serious harm.
I know doctors are often cautious about talking to families of adult patients, but I also know that times are changing. More and
more, the law and the medical community recognize that family members can be partners in care — not barriers. I am not asking for
every medical detail, but I do ask that you share what you can, and let me share what I see, so that together we can keep him safe.
I raised my son with love, and I want nothing more than to see him healthy, stable, and able to live his life. Please help me help
him. Even one phone call or a short meeting would mean so much, and could make all the difference.
[Mother’s Name]
[Address]
[City, Province, Postal Code]
[Phone Number]
[Email]
Date: [Insert Date]
Dr. [Physician’s Full Name]
[Clinic or Practice Name]
[Address]
Dear Dr. [Physician’s Last Name],
I am writing about my son, [Son’s First Name], who is 25 years old and living with a severe mental illness. His lack of insight
(anosognosia) means he cannot/won’t recognize his illness or ask for the help he needs. As a result, he has recently been engaging
in risky behaviors that place him in clear danger.
As his mother, I cannot stand by while the system treats him as if he were capable of managing this on his own. He is not. It is
precisely the nature of his illness that prevents him from seeking support, and it is precisely why the involvement of family is
most essential.
I am fully aware of privacy laws and professional obligations. But I am equally aware that recent legislative and policy changes
explicitly encourage — and in some cases require — health professionals to use their discretion to involve caregivers when patient
safety is at stake. I expect you to exercise that discretion here.
I am not asking for unnecessary personal details. I am asking for collaboration. I am asking that my observations be received, my
concerns taken seriously, and that I be given guidance on how to support my son so he does not slip further into danger.
Can you please communicate with me and specifically inform me of both what I personally need to do to best support my son and what
information I need to provide to you on an ongoing basis so that together we can support my son in the best possible ways.
Too many families like mine have faced tragic outcomes because clinicians were reluctant to involve them. I am determined not to let
that happen here. Please contact me directly by phone or email to plan our continuing cooperation. My son’s safety and future depend
on timely action, and I am holding you, as his physician, accountable for ensuring he receives the coordinated care he deserves.
[Your Name]
[Address]
[City, Province, Postal Code]
Date: [Insert Date]
Dr. [Physician’s Name]
Re: [Patient's Name] – Request for a Capacity Assessment
Dear Dr. [Last Name],
Thank you for the care you continue to provide for my [son/daughter/loved one], [Patient's Name].
I am writing because I am very concerned that [Patient's Name] has refused to allow you to communicate with me about his care. I understand that capable adults have the right to make that decision, and I respect the importance of patient privacy.
My concern is that [Patient's Name] lives with a severe mental illness and also experiences anosognosia. He does not appear to recognize that he is ill, and because of this I worry that he may not fully understand or appreciate the consequences of refusing family involvement.
As the person who provides much of his day-to-day support, I often notice early warning signs of relapse, changes in behaviour, and problems with medication that may not be obvious during appointments. When I am unable to communicate with his treatment team, I worry that important information may be missed and that his illness may worsen before anyone realizes he needs more help.
For these reasons, I respectfully ask that you consider whether [Patient's Name] has the capacity to make this particular decision about refusing consent for family communication. My understanding is that capacity involves both understanding the decision and appreciating its reasonably foreseeable consequences. Because of his lack of insight into his illness, I am concerned that he may not be able to fully appreciate the consequences of excluding his primary caregiver from his care.
I am not asking you to ignore [Patient's Name]'s rights. I am simply asking that, if you believe it is appropriate, you assess whether his illness is affecting his ability to make this specific decision.
Thank you for considering my concerns and for the care you continue to provide. My only goal is to work with you to help keep [Patient's Name] as safe and as well as possible.
Sincerely,
[Your Name]
[Phone Number]
[Email]
Envelope:
Dr. [Physician’s Name]
[Clinic or Practice Name from website]
[Address]
[Your Name]
[Address]
[City, Province, Postal Code]
Date: [Insert Date]
Dr. [Physician’s Name]
Dear Dr. [Last Name],
RE: Request for Capacity Assessment regarding Personal Health Information – (Patient Full Name]
I am writing to you as the [relationship] and primary caregiver of [ Patient Name]. As you are aware, [ Patient Name] lives with a severe mental illness characterized by significant anosognosia. While I remain committed to his recovery, I may not be able to do this effectively and safely because [ Patient name] has declined to authorize the release of clinical information to me.
I am writing to formally request that you assess [ Patient’s name’s] capacity to refuse this consent. Under Nova Scotia’s Personal Health Information Act (PHIA), capacity is defined as:
"...the ability to understand information that is relevant to the making of a decision... and the ability to appreciate the reasonably foreseeable consequences of a decision or lack of a decision."
Because [ Patient Name] lacks awareness that he/she/they is/are ill, I do not believe he/she/they can truly "appreciate the consequences" of excluding me from his care circle. Without access to information regarding his medication and the triggers for his symptoms I cannot safely monitor him at home. I ask that you determine whether his refusal is caused by his/her/their illness rather than a capable choice. If he/she/they is/are found to lack capacity in this specific area, I would be his/her/their legal substitute decision-maker for decisions regarding the disclosure of his health information and could consent to the release, to me, of any clinical information which you thought would be helpful.
I look forward to your guidance on how we can ensure [ Patient Name] remains safe and supported.
Sincerely,
[Your Name]
[Phone Number]
[Email]
Envelope:
Dr. [Physician’s Name]
[Clinic or Practice Name from website]
[Address]
[Your Name]
[Address]
[City, Province, Postal Code]
Date: [Insert Date]
Dr. [Physician’s Name]
Re: [Patient's Name] – Urgent Concerns About Safety
Dear Dr. [Last Name],
Thank you for the care you continue to provide for my [son/daughter/loved one], [Patient's Name].
I am writing because I am becoming increasingly worried about his safety. I understand that he has asked that his medical information remain private, and I respect how important confidentiality is. However, I am very concerned that his illness has reached a point where the risk of serious harm is becoming too great to ignore.
Recently, [describe the specific behaviours or incidents—for example, stopping medication, becoming increasingly paranoid, making threats, wandering away from home, acting aggressively, neglecting basic needs, or another serious concern]. These events have left me deeply concerned that he may be at risk of harming himself or that someone else could be harmed if his condition continues to worsen.
As the person who is with him most often, I am doing everything I can to support him. However, I often feel that I am trying to keep him safe without knowing enough about his treatment plan or what warning signs I should be watching for. Even a small amount of guidance could make a significant difference in helping me respond appropriately if his condition deteriorates.
I respectfully ask that you consider whether the seriousness of the current situation allows you to share whatever information or guidance you believe is appropriate to help prevent harm. I would also be grateful for an opportunity to meet with you, or to speak with a member of your team, about how we can work together to keep [Patient's Name] as safe as possible while respecting his rights.
Thank you for taking the time to consider my concerns. I know these decisions are not easy, and I appreciate your commitment to providing compassionate care. My only wish is to work with you to help protect [Patient's Name] during this difficult time.
Sincerely,
[Your Name]
[Phone Number]
[Email]
Envelope:
Dr. [Physician’s Name]
[Clinic or Practice Name from website]
[Address]
[Your Name]
[Address]
[City, Province, Postal Code]
Date: [Insert Date]
Dr. [Physician’s Name]
Dear Dr. [Last Name],
RE: Urgent Clinical Concerns and Disclosure Request – [Patient Name]
I am writing to express my grave concerns regarding my [ relationship] [ Patient’s name] current lack of stability and potential for harm. While I understand that [ Patient’s name] has expressed a desire for confidentiality, I am writing to urge you to disclose information necessary to prevent serious harm.
Even in cases where a patient is deemed capable of refusing consent, Nova Scotia’s Personal Health Information Act allows for the disclosure of information without consent if there are reasonable grounds to believe it is necessary to prevent "serious harm" to the individual or the public. Common-law cases in Canada have determined that it is often negligent not to do so.
[ Patient’s name] limited insight, combined with [mention a specific risk, e.g., medication non-compliance / escalating symptoms], has created a dangerous environment in which both of us are at risk. As the person responsible for his daily care and overall monitoring, I am unable to mitigate these risks without a clear understanding of his/her/their clinical status and safety plan.
I am asking you to exercise your professional discretion to share the information necessary to keep [ Patient’s name] safe. I would welcome a meeting to discuss how we can balance [ Patient’s name] privacy with the immediate need to prevent a serious negative outcome.
With respect and hope,
[Your Name]
[Phone Number]
[Email]
Envelope:
Dr. [Physician’s Name]
[Clinic or Practice Name from website]
[Address]