Archive | Inpatient care RSS feed for this section

Justification

12 Apr

 

It’s been a long day: first I had to explain mental illness to a psychiatrist; then I had to explain mental health cuts to my family. They know. Or they should.

That’s the thing with mental health: you’re always having to explain and justify it in a way you simply don’t have to with physical illness. No cancer doctor would see a new patient without making sure they’d read all the relevant documents first; not so in mental health. No-one would tell a relative that the reason they hadn’t got cancer treatment they needed was because they hadn’t been nice enough to the cancer clinic; not so in mental health. If I had cancer, I’d show up at the clinic and know the doctor would (or should!) have checked the slides and results first; not start from scratch. If I had cancer, family would say how awful it was that cutbacks meant I couldn’t get treatment; not that it must be because of something I’d said or done. It’s bad enough having mental health problems without also having to justify their existence – or your own worthiness to receive help.

Link here.

.

.

Who protects the rights of mental health patients?

7 Apr

 

.

Police don’t know the ins and outs of mental health law. Doctors don’t understand the difference between clinical judgment (with all its grey areas) and legal reasoning (which is more black and white) nor the limis of their legal powers. AMHPs are supposed to be the experts. But do they really protect the rights of people with mental health problems? Do hospital managers? Even a specialist mental health and criminal law solicitor got it wrong on important points of law and practice. Who is there for us, looking out for our legal rights, our human rights, when we’re at our most vulnerable?

With Martha Spurrier, former in-house council at mental health charity Mind, joining human rights charity Liberty last week as its new director, will the human rights of people with mental health problems be any more protected?

Some thoughts and conversations and more here, here and here.

.

.

Related links

 

 

.

.

“Safe” staffing on mental health wards

5 Feb

Some thoughts on “safe” staffing and what this mean on psychiatric inpatient wards.

 

.

.

.

A total smoking ban for detained psychiatric patients stinks of coercion

7 Nov

 

Following on from my piece ‘Banned by the BMJ’, below is the article which was to be published in the British Medical Journal on 7th November as part of the ‘Head to Head’ series ahead of the Maudsley debate. I was to put the ‘no’ side of the debate. This piece was written in that context with the medical readership of the British Medical Journal in mind – an audience which had never heard of me and which may have been unfamiliar with many of the materials I reference – and to the BMJ’s word limit.

.

I was detained under UK mental health law in 2011. I am a non-smoker.

Arguing that detained patients should be banned completely from smoking is, in essence, arguing that people with mental health problems should not be treated as full human beings but instead as a subset ripe for discrimination.

Everyone, including doctors, makes broad assumptions about psychiatric patients and our ability to make choices and interact with others. When we are locked up, the medical profession assumes it has the moral right to impose lifestyle changes. However, no-one is sectioned for being a smoker: we are sectioned because we’re considered a danger to ourselves or, more rarely, others. Being a smoker is not a healthcare emergency, and a mental health crisis is not the time to impose lifestyle changes.[1]

The ban on smoking inside psychiatric hospitals was introduced a decade ago, a time when people with mental health problems were side-lined far more. The indoor ban had clear aims: to create a safer working environment for staff and to respect the right of non-smoking patients to have a smoke-free surrogate home. The rights of smoking patients were protected by providing access to designated outdoor smoking areas. The aims of the outdoor ban are less clear. For example, the South London and Maudsley NHS Foundation Trust vaguely says that it aims to “create a healthier environment for everyone” and “reduce … inequality.” [2]

A complete ban prevents detained smokers without leave from smoking (or, rather, smoking overtly). It relies on the ward doors being locked. You do not increase patient “equality” by use of force. It is simply a case of “because we can”.

I am very much in favour of making psychiatric wards healthier and bringing about sustainable improvements to patients’ health. When I was fragile and detained, the ward environment was toxic. Food with no fibre, poor sleep hygiene measures, no access to exercise or fresh air, no therapy and nothing to do except sit round eating biscuits and drinking coffee – and avoid being assaulted. I was repeatedly medicated by force. I have since been diagnosed with post-traumatic stress disorder. [3] There was no smoking reduction or cessation help available. There is a great deal of scope for psychiatric hospitals to make wards healthier. [4] [5] [6]

If improving health were the reason for the ban, hospitals would make stopping smoking compulsory for staff too – 24 hours a day, even at home. That, of course won’t happen because staff wouldn’t stand for it. Unlike staff, though, patients can’t vote with their feet.

Behind all this lies a weight of history, law and medical practice which call on the entrenched notion that people with mental health problems need not be considered full human beings. The ability to use force runs through psychiatry like letters through a stick of rock. Coercion is the backbone of psychiatry. Patients experience psychiatric wards as coercive, not therapeutic.[7] [8] I was treated by force. I was locked in seclusion with no water, no food, no access to a toilet and no contact with the outside world, without even my glasses or shoes. Psychiatrists who visit wards do not truly know what goes on behind closed doors. Trusts must make wards better, not more coercive.

Where is the evidence that SLaM’s aims will be achieved by temporary enforced abstinence based on dominance, duress and fear? A ward stay is an opportunity to build therapeutic relationships with staff that may continue afterwards in the community and could lead to sustainable smoking reduction or even cessation and reduce healthcare inequalities. In psychiatry, unlike any other medical specialty, engagement with patients and persuasion are relegated to “nice to haves.” If patients can’t go elsewhere for medical advice because they are locked up and the law gives staff the right to use force, there’s no need to hone these skills.

Law and societal changes are moving towards reducing discrimination against people with mental health problems. [9] [10] [11] [12] With this ban, psychiatry is moving against the trend. This is morally indefensible and goes against patients’ rights to be at the centre of decisions about our care and treatment. Medicine shouldn’t be about imposing a doctor-dictated “fix” but helping patients to find to solutions that work in our lives.[13]

.

References:

1. Smoking and psychiatric wards – Georgia Rambles blog, Dr Georgia Belam (30 September 2014)

2. Stoptober, supporting lifestyle change and preventing psychiatric patients from smoking – Sectioned UK blog, @Sectioned_ (14 October 2014)

3. Do you remember your first time? – Sectioned UK blog (16 November 2014)

4. A smoking ban for mental health workers in the workplace – Nurse With Glasses blog, @nurse_w_glasses (15 November 2013)

5. SmokingWardipedia, a World of Ward Knowledge, @WardipediaNews

6. How can psychiatric wards become better, healthier places? – Sectioned UK blog (26 October 2015)

7. On the ward – abuse in the mental health system – Schizoaffected3 blog, @schizoaffected (27 June 2015)

8. Coercion in a locked psychiatric ward: Perspectives of patients and staff. (I asked for helps as to how to cite this link properly)

9. Code of Practice to the Mental Health Act 1983Code of Practice to the Mental Health Act 1983 (January 2015) which, for the first time, includes a section on human rights (chapter 3).

10. “The UN Convention on the Rights of Persons with Disabilities (UNCRPD) is the first human rights treaty of the 21st Century. It reaffirms disabled people’s human rights and signals a further major step in disabled people’s journey to becoming full and equal citizens.” Equality & Human Rights Commission on the United Nations Convention on the Rights of People with Disabilities (Ratified by the UK in June 2009)

11. Mental Health (Discrimination) Act 2013Mental Health (Discrimination) Act 2013 (28 February 2013) This Act removed discriminatory mental health legislation affecting MPs, school governors, company directors and would-be jury members.

12. Mental health advocacy and human rights: your guideBritish Institute of Human Rights (2013)

13. What it’s really like to work on a mental health wardIndependent, Dr Sebastian Cook (26 October 2015) 12

 

 

 

Use of force on psychiatric patients – 3 recommendations for starting to reduce the harms it causes

18 Jun

Keep calm and reduce the harm

How is the quality of inpatient mental health care measured? I’m asking a question, because I don’t know the answer and I’d be happy to learn if anyone would like to send me information.

So far as I know, the only nationally-collated and reported statistics for mental health patients are for deaths and self-harm, both of which are physical measures. It’s known that some people coming out of psychiatric hospital have had a difficult time in there, but there doesn’t seem to be much research interest in looking at why that is or how to make patients’ experiences of inpatient mental health care better. Perhaps it’s just part of what seem to be long-standing low expectations of what mental health care can achieve; perhaps it’s just accepted as a natural fact that people will dislike being detained against their will; or perhaps it’s that psychiatric patients are assumed to be a pretty miserable lot by our very nature so it isn’t the role of mental health services to try to show us a good time. I don’t know.

But I do know that I came out of inpatient detention with post-traumatic stress disorder as a direct result of what was done to me behind closed doors. I do know that I have a shoulder injury which I still receive physiotherapy treatment for more than 3 years since it was inflicted on me. And I do know that I want to try to make psychiatric care less traumatic.

To that end, I’m proposing 3 simple measures, modest proposals as a starting point to help shine a light in dark corners, with the aim of uncovering and encouraging best practice and reducing the routine use of harmful practices – a “big data” approach.

Here are my three recommendations for starting to reduce the potential of coercion and forced medication to cause harm:

.

  1. Collate and report national statistics on the use of coercion and forced medication

How is use of forced medication not notifiable? Objectively, it’s physical assault on someone, and at their most vulnerable. It would be grotesque if this were considered to be a routine and natural part of mental health ‘care’. It’s such a gross invasion of a person’s human rights that it can’t be treated as nothing. Individual hospitals may keep records, in their own ways, but there’s no uniform definition of “forced medication” & no central recording. There’s no way to know which hospitals or wards use forced medication most, where best practice is, or where injuries occur at the time or after.

Make it compulsory to record each use of forced and to report it nationally. That way, national statistics and a picture of best practice can emerge as a basis for comparisons and for developing evidenced-based interventions.

Big data is only as good as the input it’s based on, which will necessitate developing standard definitions of coercion and forced medication, to include:

  • Where force or some other form of coercion is mentioned to a patient in order to coerce them to take medication “voluntarily”.

There was a nurse on the ward where I was detained who seemed to be able to find out what patients were most afraid of then threaten them with that in order to get them to comply. In front of me he threatened one friend, who’d been moved from another ward after having been assaulted by another patient, with being sent back there if she didn’t take her medication immediately. Knowing I wanted to be seen to be complying, he twice threatened to report me to the psychiatrist if I was back late from leave.

  • Where the medication “hit squad” (called the rapid response team where I was detained) attends and stands nearby to encourage a patient to take medication “voluntarily”.

That same nurse would call the all-male rapid response team to stand outside the room of a friend whose culture kept men and women largely segregated, in order to “encourage” her to take the prescribed medication immediately. Each time, she would’ve been anxious about taking the medication and simply needed time to settle, but instead staff would become impatient and try to hurry her, making her more anxious.

  • What was done to me, namely the full 6-person take-down).

Even that may need to be spelled out because, for instance, the first time I was forcibly medicated, it states in my notes “No force used” which is simply a lie.

Such definitions will need to be worked on carefully to make it more difficult to fail to record incidents by accident, meaning any failure to record would have to be quite deliberate.

Use of forced medication is such an invasive process – state-sanctioned assault on someone at their most vulnerable – that there cannot be a justification for treating it in such a slapdash way and not even recording it. Make use of forced medication notifiable.

.

  1. Having to earning the option to use coercion or forced medication

Make the option to use of force something which must be earned, each and every time, by exhausting every alternative option beforehand, each and every time. It may suit some ward staff to go straight for forced medication as a short-cut for the purposes of ward management, but forced treatment can have damaging medium and long term effects. I remember each and every time I was medicated by force, or restrained, or held in seclusion. It is not nothing, especially when you are struggling in mental health crisis. Using force on people at their most vulnerable can cast a long shadow. It should never be a first resort.

In my case, force was the first resort every time. Not once was I offered medication and given the chance to take it voluntarily: instead, I was ambushed and drugged. I never knew when the hit squad would turn up and do it again. Even when my solicitor had advised me that the quickest way to get out of psychiatric hospital was to “comply, cooperate and engage” so I’d been first in the medication queue and had taken medication voluntarily, I was ambushed again by the hit squad the very next day. No warning, no discussion, no chance to comply. Ambushed. Repeatedly.

The Mental Health Act Code of Practice prescribes strict conditions for use of physical restraint, but not so use of forced medication. Perhaps it’s presumed that the general “least restrictive” principle will mean that forced medication will always be used as a last resort but, in my case, it was very much a first resort.

Staff haven’t just “done the right thing” because it’s the right thing to do, so it’s become clear they must be made to do so. Detailed guidance on the prerequisites for use of forced medication (and sanctions for contravention of procedures) are necessary.

.

  1. Debrief patients after each use of forced medication

After each use of forced medication, I’d simply be left, abandoned in dirty sheets. The first time it was done to me, I got up, pulled up my trousers to cover my buttocks then ran down the hall after the departing staff asking them what they’d just injected me with, what it was for, what I could expect to feel, how long it would last – but received no response. They continued walking away down the corridor without responding to me once. Not one of them even so much as turned their heads to acknowledge I was speaking. And in the meantime they chatted away to each other. I was left to return to my bed space feeling confused, humiliated, anxious, violated, not knowing what had been done to me or why or what would happen next. I’d been violated in my bed but had no change of clothes or change of sheets. None of my questions was ever answered. I only learned what drugs had been administered to me when I received a copy of my medical records, months later.

Each time after that, the pattern was the same except that I no longer ran after the staff trying to ask questions but would just be left stunned in my bed space, having been subjected to ambush medication yet again. Left in soiled sheets with my bed pulled out from the wall, having to somehow try to piece together my dignity and try to get some clean sheets and clean clothes, so shocked I’d quietly creep around in slow motion, trying to process what had just been done to me. Shocked again, brutalised again. I think the worst time was the time they came for me even when I’d taken the medication voluntarily; it seemed that nothing I said or did would make them stop.

I learned after coming out of hospital that it’s routine practice for staff to be debriefed after having been involved in a use of forced treatment. Staff are professionals at their place of work, but patients on a psychiatric ward are at our most vulnerable – so why aren’t patients debriefed too? It’s common sense. At the very least, the forced medication process is a very intense experience for people who are poorly, more so than for trained staff who are healthy. It’s clear that forced medication has the potential to harm patients. Good mental health staff want to reduce the harm caused to patients. Let’s do it.

People who choose to train as mental health nurses, occupational therapists, doctors or healthcare assistants don’t for the most part choose their career in order to leave people so traumatised they come out of hospital vowing never to go back into “that place” again, terrified to ask for help, even with post-traumatic stress disorder. Of course, in every profession, there will be a few rogues and, just as professions giving power over children attract sexual predators, so psychiatry will attract some people who want to exert power behind closed doors over vulnerable people who won’t be believed if they speak up about what’s been done to them. People with both good and bad intentions go into mental health services; knowing that to be the case, how can mental health services, especially inpatient wards, be designed so that the good intentions of the former are the most practical option to express but the bad intention of the latter are harder to express? At present it seems that inpatient wards facilitate bullies and brutes, encouraging those who are like that to start with and pushing those who went in with good intentions to become bullies and brutes to or at the very least inured to cruelty and lack of compassion.

In order to challenge endemic use of forced medication, first the evidence of its use must be gathered.

If you’re wondering what I mean by “forced medication”, this’ll give you a flavour:

There is no measure of quality of mental health care but, just as statistics for pressure ulcers are gathered as a signal that

From the Stop the Pressure 2014 slide presentation

From the Stop the Pressure 2014 slide presentation

something’s going wrong on a physical healthcare ward, so statistics about the use of coercion and forced medication can be used as an indicator that something’s not quite right in mental health care. I don’t know all the healthcare or NHS jargon but comparing use of force in psychiatric care to pressure ulcers, where are the CQUIN goals to reduce use of force? Should each use of force be recorded as a ‘serious incident’? The above are modest recommendations intended to be simple, doable steps to reduce harm to patients of forced medication. How can these steps be brought about? Are there better ones and if so what are they? What needs to be done? What’s the first step in making this a reality? Put your thinking caps on and let me know!

.

.

.

Related links:

.

.

.

Mental health and human rights: Why aren’t human rights groups interested in mental health folks?

17 Mar

Healthcare is a human right.

Why aren’t human rights groups interested in the human rights of people with mental health problems, especially when there’s so much for them to get their teeth into? Is it just the same ol’ ignorance and prejudice?

When a human rights story is in the news, you’ll see me banging on about it on twitter and asking where the coverage of the human rights of mental health folks is. I’ll ask why human rights organisations don’t seem interested in this group of people, who can in many cases genuinely be classed as some of society’s most marginalised and vulnerable: sometimes locked up behind closed doors, often out of sight, with little credibilty and subject to state powers to impose forced treatment on people even when they have mental cacpacity. Why don’t we hear about that all day and all night from human rights organisations?

Lancet Psychiatry human rights

This silence from human rights groups is puzzling when mental health issues are receiving more publicity and prominence and where there is so very much for human rights groups to get their teeth into. That leads me to ask all sorts of questions. For instance:

  • The Convention on the Rights of Persons with Disabilities

I’ll ask why human rights organisations don’t seem to be interested in a brand new developing area of rights, namely those under the Convention on the Rights of Persons with Disabilities (CRPD) which has been described as a paradigm shift in disability rights. Don’t they want to get in on the action on this hot new area, rather than sticking doggedly with familiar human rights aspects? Are human rights organisations bound to stay in the familiar niches they’ve carved for themselves, or will they look further afield?

  • United Nations investigation into violations of the rights of disabled people

I’ll ask whether human rights organisation are looking at the fact that the UK is the very first country to be investigated by the United Nations for violations of the human rights of disabled people under the CRPD. Doesn’t that sound like an interesting and important human rights topic?

  • Human rights section to the new Code of Practice to the Mental Health Act

I’ll ask what human rights organisations are doing about the brand new section at the front of the new Code of Practice to the Mental Health Act on … human rights. Isn’t it significant – something of note, something to promite – that the new CoP has at its very beginning a brand new section on human rights? I think so. Is it only me?

  • Care Quality Commission’s new human rights-based approach

Are human rights organisations interested in the human rights-based approach all Care Quality Commission inspectors are to take to inspecting hospitals and other healthcare facilities?

  • Restrictions placed on psychiatric detainees

Do they take an interest in the recent NICE guidance that all NHS hospitals should prevent smoking on their premises, even in the case of detained patients without leave and are there no human rights implications of that blanket policy (spoiler: yes)? And what of the blanket policies of some hospitals to remove patient phones or prohibit them from accessing social media whilst on ward?

  • Routine use of force medication

Forced medication is used on some psychiatric wards as a matter of routine, as a first resort rather than a last resort, even when people have the mental capacity to make medication decisions for themselves. Aren’t the human rights of people subjected to forced medication in psychiatric detention of interest to human rights groups?

  • Voting rights of psychiatric patients

Voting rights are meat and drink for human rights organisations. So why no campaigns or even interest in the voting righs of people with mental health problems?

Mia Vee human rights votin

Why is it? Why don’t human rights groups take an interest in those topics when there’s so much for them to get their teeth into and when mental health is such a hot topic at the moment, often in the news?

Mental health folks don’t seem to get a mention – unless we fall into an existing favoured category such as prisoners, death row inmates or deaths in custody

When I see human rights organisations talking about human rights, I notice time and again that, whilst all sorts of different niche groups and causes are trumpeted, mental health folks just don’t seem to get a mention – unless, that is, we fall into an existing favoured category, such as people in detention in prison or on death row, or deaths in custody. Why is that? And what – given important developments in human rights and current social and political changes giving mental health much more prominence – can be done to get violations of the human rights of mental health folks more of a focus and the enforcement of the human rights of mental health folks made into more of a priority?

Why am I told mental health folks are “too speciailst” when all sorts of other specialist groups are chosen for human rights campaigns?

I’ve tried to follow up with various human rights organisations to find out about the work they do on the human rights of mental health folks. I’ve tried. However, I’ve typically been ignored or, when I do get a response, I’m fobbed off with the line that people with mental health problems are a niche group that’s “too specialised” for them. This doesn’t seem to accord with campaigns run in respect of other “niche groups”, such as refugees, prisoners, LGBT people, trades union members, military personnel. Not at all. And it goes against the premise that human rights are most needed by those people who are most vulnerable – and people with mental health problems can be in very vulnerable postions. It’s niche groups who most need human rights.

Justice Hub human rightsEurorights human rightsHuman rights nicheWhy the seeming lack of interest from human rights organisations? Why are people with mental health problems being marginalised, even by those organisations and individuals who purport to champion society’s most marginalised and vulnerable people? Why – at a time of expanding human rights provisions for people with disabilities including mental health problems, at a time of increasing promimence for mental health issues growth, development and prominence of issues surrounding people with mental health problems – why are human rights organisations not swinging into action and grasping the opportunties available to do good, high profile work and make a real difference to the lives of mental health folks?

Human rights stigma discrimination

Could it be that human rights organisations are simply prey to the same ol’ same ol’ stigma and discrimination that blights the lives of mental health folks every day? Is it a case of priorities and people managing mental health problems just aren’t as important as other groups – even though we make up such a large minority of the population? I’m still trying to find an answer.

I’ll keep on trying. The human rights of people managing mental health conditions are too important to overlook.

.

.

Web links thumbnail.

.

Related links

.

Some human rights organisations
BIHR mental health advocacy guide

BIHR course for mental health workers FEB 2015

.

.

Some human rights laws and conventions

.

Some twitter musings on human rights for mental health folks:

.

Mental health and human rights: What have human rights ever done for me?

10 Mar

Human Rights Act 1988 Articles BIHR

Human rights are for everyone and they affect our lives every day, epecially the lives of people managing mental health problems: the more vulnerablle and marginalised a person is, the more important human rights are.

.

You’ll often see me banging on on twitter about human rights (often using the hashtag #humanrights). Why have I got such a bee in my bonnet about human rights? Aren’t they just for journalists locked up in foreign jails, prisoners banned from voting or from being sent books, refugees? Aren’t they just about freedom of expression, torture, death row inmates? And why do they even matter if the government scraps the Human Rights Act, as we’ve heard the Conservative party propose recently? These are all important questions.

See Me Scotland human rightsHaving been unlawfully arrested by police; detained under section against my will; repeatedly forcibly medicated; held in seclusion; locked in a room for hours with no access to a toilet, bedding, food or water or even shoes; locked up without my glasses, phone or any means to contact the outside world – I referred to the psychiatric ward as The Land that Human Rights Forgot – and subsequently left, in a fragmented NHS mental health system, without proper care in the community, the let me tell you: I am very much a fan of human rights for mental health folks. And I think they are worth fighting for.

Human rights are for everyone and that includes people with mental health problems

Yes, human rights are for all those different types of people listed above; and yes, they are about all of those important issues, which mainstream human rights organisations talk about regularly. But they’re not about only those issues or about only those people. Human rights are for you, me, people we like, people we hate, people we don’t know. Human rights are for everyone, and they affect our lives every day – especially the lives of people managing mental health problems. The more vulnerablle and marginalised someone is, the more human rights has the scope to help.

There have been some important legal cases decided by courts in the recent past which have forced important changes to be made to the ways people with mental health problems are treated, especially when in crisis; and there is scope in future for human rights laws, guidance and conventions to bring about more improvements to our lives. Human rights laws exist to protect everyone from abuses of power, disrespect and neglect.

Human rights laws, guidance and conventions can help to bring about more improvements to the lives of people with mental health problems

Recently, barrister Adam Wagner, who writes for the UK Human Rights blog, set up a new project, the Human Rights Information Project. It aims to “change the face of human rights” by aiding public understanding of the topic and why it’s important. It must, in my view, try to bring home the fact that human rights are for everyone, and that includes people with mental health problems.

In kicking off the new project, Wagner asked people to nominate their top UK and European human rights legal cases. He’s putting together a top 50 of human rights cases which have had a “profound impact on people in the UK” or which have the potential to do so (#50cases). In response to that call, I spotted this blog by Lucy Series (a researcher at the Centre for Health and Social Care Law at Cardiff Law School), which sets out her top 16 human rights cases on mental health, disability rights and capacity law. Over the course of my pifflings on on twitter, I’ve randomly stumbled across a few other legal cases on the human rights of people managing disabilities, including mental health problems. Scroll down to find the case summaries I put together and sent to Wagner; my aim is for cases on disability rights and human rights for people with mental health problems to make it into the top 50: I want mental health folks to be seen as falling squarely within mainstream human rights concerns, rather than in a specialist niche or only in relation to other pre-existing areas of focus like prisoners or deaths in custody.

I want mental health folks to be seen as falling squarely within mainstream human rights concerns, rather than in a specialist niche

There are many areas in which legal cases brought either in the UK courts under the Human Rights Act 1998 or the European Convention on Human Rights or the Convention on the Rights of Persons with Disabilities have led directly to changes in UK law and policy that impact our daily lives. These include:

  • The Code of Practice cannot just be ignored

Hospitals now know (because of the Munjaz case) that they cannot treat the Mental Health Act Code of Practice as optional; they must always follow what it says, unless they  can show they have good reasons not to do so. Knowing this can help focus the minds of those writing in-house policies; and give patients or advocates the chance to persuade hospitals to stick to the Code – or to know the reasons why they’re not doing so.

  • Mental Health Crisis Care Concordat brought in to set national standards & force services to collaborate

Following MS v UK, the NHS now knows it cannot leave someone in acute mental distress in a police cell for days, since this is degrading treatment that breaches human rights. As a result of this case, in 2014 the government introduced the Mental Health Crisis Care Concordat which sets national standards for crisis care and requires signatories (including local government and key health, police and voluntary services) to work together to develop strategic partnership arrangements and hold each other to account.

  • The state must provide a system of public healthcare

The State must provide a system of public health care and hospitals. A case from Turkey shows that the European Court of Human Rights has begun to develop a “right to healthcare” under Article 2. This may prove a potential source of legal challenges to cuts to NHS healthcare services, cuts which are falling disproportionately harshly on historically-underfunded mental health services and, in the case of child mental health servivices, could be argued not to provide a ‘system’ at all.

  • Hospitals must care for voluntary patients too

Hospitals must take just as good care of voluntary patients as they do sectioned patients (Rabone). This was an important extension of the duties of hospitals to care for informal patients too.

  • Mental Capacity Act brought into law to protect vulnerable people

Following the Bournewood case, the government brought in the Mental Capacity Act 2005. This gives extra protections to people who are unable to make decisions for themselves and find themselves deprived of their liberty, including people with learning difficulties, and/or mental health conditions and older people in care homes. The Act gives people some right to be listened to and be consulted about various aspects of their human rights.

  • Safeguards against detention of vulnerable people

What amounted to being deprived of your liberty was clarified in the Cheshire West (‘gilded cage’) case, and people now have more procedural safeguards. This has had a significant impact on health and social care services since people who it was previously thought could not have a say now do.

All sorts of aspects of human rights affect people with mental health problems, and not just obvious ones like psychiatric detention and forced treatment in the UK, or people chained or caged overseas. I don’t mean horror stories detailed in the Scientologists’ “Psychiatry: an Industry of Death” museum (don’t be confused by the Citizens’ Commission on Human Rights, which is just another manifestation of Scientology) or current or past uses of psychiatry for political means. I’m thinking about these sorts of issues which, to my mind, provide lots of opportunities for human rights to make a real difference to people’s lives:

  • The right to vote of people with mental health problems
  • Discrimination in employment
  • The impact and implementation of the new United Nations Convention on the Rights of Persons with Disabilities, which has been described as “a paradigm shift in disability rights” (though, unlike the European Convention on Human Rights, it has not yet been implemented into UK law.)For instance:
    • How does the CRPD right to access treatment square with historic underfunding of NHS mental health services or the greater cuts applied in comparison with physical health services? Access to good, timely treatment and support is a key issue for people managing mental health problems.
    • The UK is the first country to be investigated by the UN for systemic violations of the rights of disabled people; when poverty is a major determinant of mental health problems, austerity cuts are falling disproportionately on disabled people, particularly people with mental health problems.
  • Routine use of forced treatment on people with (and without) mental capacity held in psychiatric detention
  • The brand new human rights section at the start of the revised Code of Practice to the Mental Health Act

Mia Vee human rights votinLet’s not take our human rights for granted and lose them by not paying close enough attention, or miss the opportunity for gains that, for instance, using human rights language in negotiations can bring.

.

.

.

Summaries of some important legal cases on the human rights of people with mental health problems

Rights Info 50 cases

Here’s my (short) list of legal cases which have impacted (or have the potential to do so) on the human rights of people with mental health problems. These are summaries of the ones I’ve randomly stumbled across, so please feel free to add more in the comments underneath. Wagner asked for cases to be listed in order of importance, and for each case to include the name, citation (like a library catalogue reference) and link in a legal database, together with a 50-word summary. I’ve had a go – though fairly swiftly ditched the word limit. First I describe some brief facts of the case, then what the court decided, then it’s significance (in my view).

.

1) Hospitals can’t ignore the Mental Health Act Code of Practice but must always follow what it says unless they have good reasons not to do so

R v. Ashworth Hospital Authority (now Mersey Care National Health Service Trust), ex parte Munjaz, House of Lords, [2005] UKHL 58

In 2004, Mr Munjaz, a patient at Ashworth high security psychiatric hospital, was placed in seclusion. Chapter 15 of the Code of Practice to the Mental Health Act 1983 contains provisions on seclusion, from which Ashworth’s policy differed.

The House of Lords found that, although the Code was less than a “binding instruction” to be followed always, it was “much more than mere advice”; instead, it was statutory guidance from which a hospital “should only depart if it has cogent reasons for doing so”. (In this case, the hospital was found to have such reasons.)

The Code has historically been poorly adhered to by hospitals and healthcare staff (it was certainly my experience as an inpatient that staff had a poor understanding of the law or any regard for the Code), and the case was an important reiteration of its weight. The ruling will take on increased significance in April 2015, when the revised Code will come into force: th

e new Code will bring human rights to the fore, since it opens with a new section on the human rights of patients. Watch this space!

.

2) The NHS can’t leave someone in acute mental distress in a police cell for days, since this is degrading treatment that breaches human rights

M.S. v. the United Kingdom, European Court of Human Rights, May 2012, Application no. 24527/08

In 2004, police detained MS under s136 Mental Health Act 1983 and took him to police cells as a “place of safety” for assessment. At the outset, a number of specialists assessed MS as being in urgent need of psychiatric treatment for severe mental illness. Nevertheless, for 4 days, whilst waiting for a bed in a mental health unit to be organised, he continued to be held in a police cell, monitored by CCTV. Without treatment, he quickly descended into an “abject condition” and was manifestly suffering acutely.

The Court held that MS had suffered degrading treatment, in violation of his rights under Article 3 of the Convention. (The description of MS’s suffering contained in the judgment is truly horrifying.)

This ruling p

laced the onus on the UK government to ensure provision and coordination of services for dealing with urgent mental health cases. Being unprepared was no justification for breaching best medical practice and the maximum time limit set by law. The case also recognised, in contravention to what government lawyers had argued, that mental suffering was suffering and that it was insufficient for his physical safety and (just barely) physical needs alone to be catered for.

Following this case, in 2014 the government introduced the Mental Health Crisis Care Concordat. It sets national standards for crisis care and requires signatories – including local government and key health, police and voluntary services – to work together to develop strategic partnership arrangements and hold each other to account. Another case of Watch this space!

.

3) The State must provide a system of public health care and hospitals

Asiye Genç v Turkey, European Court of Human Rights, January 2015, Application No 24109/07

In 2004, a newborn baby died in an ambulance after being refused treatment for urgent breathing difficulties at three hospitals in the region; each hospital had said it had no suitable or available neonatal facilities and had turned the ambulance away. Truly heartbreaking.

The Court found that the Article 2 ECHR right to life had been violated, and that the State has a positive obligation to provide a system of public health care and hospitals.

The case shows the Court has begun to develop a “right to healthcare” under Article 2. This may prove a potential source of legal challenges to cuts to NHS healthcare services, cuts which are falling particularly harshly on historically-underfunded mental health services. The duty is to provide a healthcare system which is well-equipped, well-run, accessible and of good quality – not something which can always be said of mental health services in the UK.

.

4) Hospitals must take just as good care of voluntary patients as they do sectioned patients

Rabone and another v Pennine Care NHS Foundation Trust, Supreme Court, [2012] UKSC 2, [2012] MHLO 6

In 2005, Melanie Rabone, a psychiatric inpatient assessed to be at real and immediate risk of suicide, took her life the day after the Trust negligently allowed her to go home on leave.

Rabone had been admitted a week earlier after a serious suicide attempt. She was undergoing treatment for a severe depressive episode with psychotic symptoms and was a voluntary or “informal” patient (not formally detained under the Mental Health Act 1983). Her records noted that, if she attempted to leave, she should be stopped and assessed for detention under the Act. Nevertheless, she was granted home leave and took her life the next day.

The Supreme Court found that the Trust owed a positive operational duty under Article 2 ECHR (right to life) to take preventative measures to safeguard the life of a patient at risk of suicide irrespective of whether she was an informal or detained patient.

The judgment recognised that voluntary psychiatric inpatients are owed the same practical and legal protections as sectioned patients; and shows the vital role the Convention can play in protecting the human rights of society’s most vulnerable people.

.

.

Web links thumbnail

 

.

.Related links

.

.

Human rights laws and conventions
Some twitter musings on human rights for mental health folks:

.

.