As I write this review, British soldiers are appearing anonymously behind screens in courts to discuss the Bloody Sunday shootings of 1972, and the jury reads Princess Diana's letters in silence so as not to disclose their secrets. In court, a journalist has been ordered to divulge his source of information from Ian Brady's confidential medical records. Jeffrey Archer has named inmates he encountered in prison, and has been punished for this. Confidentiality — and disclosure — is always in the news.

Once upon a time, it may have been straightforward to determine the boundaries of confidentiality. That was before the GMC, BMA, MRC and Royal College of Psychiatrists issued guidelines. The report of the Caldicott Committee in 1997, the Human Rights Act 1988 and the Data Protection Act 1998 have all sought to reduce the unnecessary flow of information, but multi-agency public protection panels and the National Service Framework demand communication with others. In recent years, it has become difficult to know what a secret is — or should be. It is easy to be paralysed by uncertainty about whether to disclose information or to maintain secrecy.

This book sprang from a conference in Sheffield in 1998, and thus has the strengths and weaknesses of conference proceedings. It is inconsistent and variable in style. It will date. Nevertheless, it is far more helpful than the plethora of guidelines issued by the acronymic organisations above. Rather than laying down graven principles, this volume seeks out the interstices of understood practice. Consequently, its focus is on practical difficulties rather than ensuring that one can adhere to the law. The authors attack the subject from a number of angles and are pleasingly multi-disciplinary.

The specifics of this book are the milieux in which psychiatrists are challenged by the dilemmas of confidentiality and its mandated breach, in either private or public interest. The volume covers children, psychoanalysis, prisons and research. Approaches are variably psychodynamic, ethical, legal and clinical. The multi-author approach works well in expounding the different needs of specific populations of patients. Some chapters shine: Fulford, Szmukler & Holloway, Bailey and Kaul are particularly provocative and helpful. In discussions about, for instance, whether to disclose confessions of paedophilia and risk the therapeutic relationship, this book is instrumental in laying bare the underlying issues. No simple guidelines could ever address the complexity of such issues.

It is unreasonable to expect that any single volume will provide a do-it-yourself guide sufficient to manage the subtle and varied situations that delineate the tension between privacy and disclosure. However, a strong approach would seek to define the terrain in which the problem is set and then develop themes that explain why some approaches are justified and others are not. This volume succeeds in these tasks, not just as an academic text but as a practical help. I recommend it highly.