This opinion piece first featured on The British Institute of Human Rights guest blog. The views expressed belong to the author.
The Human Rights Act is embedded within everything we do in Mental Health services. The rights it contains work intuitively within our governance and legal frameworks and inform our decision making in relation to individual care, upwards towards service planning and transformation. They hold organisations to account and focus our intentions on what care we deliver.
Whoever we are – staff, service users, families and carers – we all have human rights, and these must be protected and upheld within all aspects of our work. Cultures develop within services when staff and services are under pressure.
Sometimes, when services are short of staff, care settings can look to identify ways of managing time more effectively, often at the expense of service users’ liberty or freedoms. We risk care becoming mechanical and task-orientated, rather than individual and person-centred. Holding the Human Rights Act in mind helps us to avoid falling into this way of delivering care, especially to those who are most vulnerable.
Restrictions are often put in place because of fear
When a serious incident occurs, often the reaction of organisations is to restrict liberties and basic rights, such as the right to a private life, in the interests of patient and staff safety. Items brought into the wards and contact with families and friends can both be restricted, often due to the fear of another incident occurring.
Security concerns within in-patient settings can result in doors being locked to prevent access by the public, yet patients who are informal and are free to leave the ward at any time are required to ask permission to leave. Access to the internet or mobile phones can be restricted for fear of the potential for grooming, exploitation or requesting access to contraband items and harmful substances, such as drugs or items that can be used to self-harm. All of these things are done with good intentions.
As a nurse, you want to care for your patients, yet, in doing so, you can risk becoming paternalistic and want to protect rather than empower. Teams can do the same, responding to such events by imposing blanket restrictions to safeguard those for whom they care.
The Human Rights Act plays a vital role
The systems we have in place to protect those in our care can become so risk-focused that the challenge for frontline practitioners is that the impact of protecting individuals can soon develop into blanket restrictions and polices.
The Human Rights Act is there to remind us that the individual needs to be behind every decision that is made. Their illness, family, wishes, beliefs and cultural backgrounds are unique to them, and a restrictive policy that prevents risk does not fit all people – there has to be flexibility and compromise.
When we think about the language we use in healthcare settings, it acts almost as a furniture of separation, separating us from individual care – safeguarding, risk management, restraint. They are all necessary components of care and safety, but they have to be used within the context of human rights.
The right to family life
Healthcare services use the Human Rights Act to offer a compromise – offering safe care that does not inhibit someone’s right to a family life. A good example of this is the adoption of a mobile phone policy that allows all patients access to a phone so that they can remain in contact with family and friends.
To protect the patient from possible harm, as noted above, an agreed care plan could be utilised to manage this safely, which may include a phone that cannot access the internet. This can then be adopted on an individual basis, rather than a blanket approach of an outright ban on phones for patients in mental health wards.
The question we should always be asking…
The Human Rights Act matters to me because it puts service users at the heart of everything we do – we should always be asking the question about patient safety alongside what is in the best interests of that individual, what that person wants, is that what they need, what do they think, how would you like to be treated in a similar situation?
Using a rights-respecting approach supports practitioners to hold the Human Rights Act in mind when we deliver care and this enables patients to be safe from harm without using blanket restrictions.