Human Rights Of Mentally Ill

HUMAN RIGHTS OF MENTALLY ILL In 1973 the American Hospital Association (AHA) issued a patient’s rights that many hospitals and community based settings have adopted. These rights were reaffirmed in 1990. In 2003 this document evolved into “The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities”. This document is often given to patients on admission and read or explained to them. The psychiatric patients currently have the following rights • Right to communicate with people outside the hospital through correspondence, telephone, and personal visits • Right to wear clothing and personal effects with them in the hospital • Right to religious freedom • Right to be employed if possible • Right to manage and dispose of property • Right to execute bills • Right to enter into contractual relationships • Right to make purchases • Right to education • Right to habeas corpus • Right to independent psychiatric examination • Right to civil service status • Right to retain licences, privileges, or permits established by law, such as a driver’s or professional licence • Right to sue or be sued • Right to marry and divorce • Right not to be subject to unnecessary mechanical restraints • Right to periodic review of status • Right to legal representation • Right to privacy • Right to informed consent • Right to treatment • Right to refuse treatment • Right to treatment in the least restrictive setting Some of these rights deserve a more thorough discussion. Right to Communicate With People Outside the Hospital This right allows patient to visit and hold telephone conversations in privacy and send unopened letters to anyone of their choice, including judges, lawyers, families, and staff. Although the patient has the right to communicate in an uncensored manner, the staff may limit access to the telephone or visitors when it could harm the patient or be a source of harassment for the staff. The hospital also can limit the times when telephone calls are made and received and when visitors can enter the facility. Right to Keep Personal Effects The patient may bring clothing and personal items to the hospital, taking into consideration the amount of storage space available. The hospital is not responsible for their safety, and valuable items should be left at home. If the patient brings something of value to the hospital, the staff should place it in the hospital safe or otherwise provide for maintaining a safe environment and should take dangerous objects away from the patient if necessary. Right To Enter Into Contractual Relationships

The court considers contracts valid if the person understands the circumstances of the contract and its consequences. Once again, a psychiatric illness does not invalidate a contract, although the nature of the contract and degree of judgement needed to understand it are influencing factors. Incompetency. Related to this right is the issue of mental incompetency. To prove incompetence in court, all of the following must be shown: • The person has a mental disorder. • This disorder cause a defect in judgement. • This defect makes the person incapable of handling personal affairs. The psychiatric diagnosis of the patient is not important. If a person is declared incompetent, the court will appoint a legal guardian to manage his or her affairs. If ruled incompetent, a person cannot vote, marry, drive, or make contracts. Right to Education Many patient exercise the right to education on behalf of their emotionally ill or mentally retarded children. The U.S. Constitution guarantees this right to everyone, although many states have not provided adequate education to all citizens in the past and are now required to do so. Right to Habeas Corpus Habeas corpus is an important constitutional right patients retain in all states even if they have been involuntarily hospitalized. It provides for the speedy release of any person who claims to be detained illegally. A committed patient may file a writ at any time on the grounds of being sane and eligible for release. The hearing takes place in court, where those who wish to restrain the patient must defend their actions. Patients are discharged if they are judged to be sane. Right to Privacy The right to privacy implies the person’s right to keep some personal information completely secret or confidential. Confidentiality involves the nondisclosure of specific information about a person to someone else unless authorized by that person. Every psychiatric professional is responsible is responsible for protecting a patient’s right to confidentiality, including even the knowledge that a person is in treatment or in a hospital. Revealing such information might result in damage to the patient. The protection of the law applies to all patients. The Health Insurance Portability and Accountability Act (HIPAA,2003) is the first comprehensive privacy protection act which guarantees patients four fundamental rights related to the release of information: 1. To be educated about HIPAA privacy protection 2. To have access to their own medical records 3. To request correction or amendment of their health information to which they object 4. To require their permission for disclosure of their own personal information. Right to Informed Consent The goal of informed consent is to help patients make better decisions. Informed consent means that a clinician must give the patient a certain amount of information about the proposed treatment and must attain the patient’s consent,

which must be informed, competent, and voluntary. Information to be Disclose in Obtaining Informed Consent Diagnosis Description of the patient’s problem Treatment Nature and purpose of the proposed treatment Consequences Risks and benefits of the proposed treatment including physical and psychological effects, costs, and potential resulting problems Alternatives Viable alternatives to the proposed treatment and their risks and benefits Prognosis Expected outcomes with treatment, with alternative treatments, and without treatment. In obtaining informed consent the clinician should adhere to the principles listed above. Right to Treatment Early court cases extended the right to treatment to all mentally ill and mentally retarded people who were involuntarily hospitalized. The courts defined three criteria for adequate treatment: 1. A humane psychological and the physical environment 2. A qualified staff with a sufficient number of members to administer adequate treatment 3. Individualized treatment plans Most important is the requirement for an individualized treatment plan. Failure to provide it means that the patient must be discharged unless he or she agrees to stay voluntarily. Failure to provide it means that the patient must be discharged unless he or she agrees to stay voluntarily. Right to Refuse Treatment The relationship between right to treatment and right to refuse treatment is complex. The right to refuse treatment includes the right to refuse involuntary hospitalization. It has been called the right to left alone. The involuntary therapy conflicts with two basic legal rights: freedom of thought and the right to control one’s life and actions as long as they do not interfere with the rights of others. Right to Treatment in the Least Restrictive Setting The right to treatment in the least restrictive setting is closely related to the right to adequate treatment. Its goal is evaluating the needs of each patient and maintaining the greatest amount of personal freedom, autonomy, dignity, and integrity in determining treatment. This right applies to both hospital-based and community programs. Another consideration in the least restrictive alternative is that it applies not only to when a person should be hospitalized but also to how a person is cared for. It requires that a patient’s progress be carefully monitored

so that treatment plans are changed based on the patient’s current condition. Role of Nursing The National League for Nursing (1977) issued a statement on the nurse’s role in patient’s rights. The league urged nurses to get involved in ensuring patient’s human and legal rights. The league identified many of the previously mentioned rights, plus the following: • Right to health care that is accessible and meets professional standards, regardless of the setting • Right to courteous and individualized health care that is equitable, humane, and given without discrimination based on race, colour, creed, sex, national origin, source of payment, or ethical or political beliefs • Right to information about their diagnosis, prognosis, and treatment, including alternatives to care and risks involved • Right to information about the qualifications, names, and titles of health care personnel • Right to refuse observation by those not directly involved in their care • Right to coordination and continuity of health care • Right to information on the charges for services, including the rights to challenge these charges • Above all, the right to be fully informed about all their rights in all health care settings. Perhaps the most important factor in ensuring patient’s rights are the attitude, knowledge, and commitment of the mental health professional.