Patricia Murphy, CBT Therapist and Associate Editor of BABCP's official magazine CBT Today, recently attended a BIHR training session for third sector professionals on mental health and human rights. In this blog, reposted from CBT Today, she reflects on BIHR's work to highlight why paying attention to human rights should matter to clinicians.

Around the world human rights are about real everyday lives. As clinicians, we have a duty to ensure that the rights of our patients are protected. Given the importance of human rights, then, it is surprising that there has been little public education about what is contained in the Human Rights Act (HRA), which came into force in the UK in 2000. This state of affairs is one that the British Institute of Human Rights (BIHR) has been working hard to rectify.

Founded over 40 years ago, BIHR is an independent body that aims to provide the public with authoritative and accessible information through campaigning, organising community events and awareness training, producing fact sheets and other resources, and issuing legal and policy briefings.

BIHR’s mission statement is clear:

At the heart of everything we do is a commitment to making sure the international promise of the Universal Declaration of Human Rights, developed after the horrors of World War II, is made real here at home.

Our innovative work seeks to achieve a society where human rights are respected as the cornerstone of our democracy and enable each of us to live well in communities that value the equal dignity of each person.

Their expertise was critical to the production of Human Rights in Healthcare - A Framework for Local Action, which was the result of a collaboration between BIHR, the Department of Health and five NHS Trusts. Published in March 2007, the purpose of this framework is to support NHS staff and commissioned providers to fulfil their specific duties effectively under the HRA.

More recently, in 2014, BIHR issued an open invitation to service providers from every region to work in partnership on the innovative Department of Health-funded project, Connecting Human Rights to the Frontline. The only criterion was that applicants had to have a role in mental health care provision or decision-making on mental capacity issues. This had to be coupled with a commitment to tackle their legal duties under the HRA.

The seven project partners that were selected included the North and South Tees Early Intervention Psychosis Teams, the St Aubyn’s CAMHS centre based in Essex, and the NHS-run Windswept rehabilitation service in Bristol.

I recently attended a training day in London hosted by BIHR for the third sector, as part of their ongoing commitment to educate and inform. This event provided not only an opportunity to build on existing knowledge of the HRA, but also to consider the relationship between mental health and human rights as well as reflect on the ways in which human rights are relevant to working with people who use mental health services.

Delegates were reminded that human rights provide a vital safety net that goes beyond the courtroom to transform and improve the experience of those using public services and everyone's quality of life generally. In mental health it means that we have a legal duty to comply with the HRA when making clinical decisions about patient care. It also means that we have a professional duty to ensure that we can identify a human rights issue and use the HRA to frame a challenge.

Our excellent trainer Stephanie Davies provided details of real life cases where human rights were found to have been breached, while vignettes were used to facilitate discussion in smaller groups to test our working knowledge of the HRA and identify violations. Examples included: a patient detained under Section 3 of the Mental Health Act (MHA) waiting eight weeks for a tribunal hearing; a man being arrested and detained for more than 72 hours in a police cell coming to harm; and a 51-year-old man with Down’s Syndrome and dementia having a 'do not resuscitate' order placed on his file without any consultation with him or his family.

It was sobering to reflect on my personal clinical experience spanning 30 years in mental health and recall all too easily instances when there were clear breaches of the HRA that went unchallenged. Take the common clinical practice of ‘specialing’, or the constant observation of suicidal or other vulnerable patients, which has the potential for human rights infringement, as constant observation often causes conflict amongst patient and staff and can interfere with recovery. Clearly keeping a vulnerable patient safe is paramount but, in order to do so, clinical decisions may be arrived at that violate a patient’s human rights, so a balancing act is required to ensure proportionality.

Evidently the ability to identify a human rights issue requires a working knowledge of the HRA and it is important to emphasise that not all rights carry the same weight. They can be grouped into three broad types:

• Absolute rights, such as the right to protection from torture and inhuman and degrading treatment, which the state can never withhold or take away

• Limited rights, such as the right to liberty

• Qualified rights, which require a balance between the rights of the individual and the needs of the wider community or state interest, such as the right to manifest one’s religion or beliefs, the right to a private and family life, the right to freedom of expression, the right to education, and freedom of assembly and association

BIHR has produced a range of resources designed to support mental health advocacy, which can be found on their website, including a handy eight-step flowchart explaining the steps.

Although the work undertaken by organisations like BIHR is invaluable, the HRA does have its share of detractors and appears to divide public opinion. Moreover, the recently elected Conservative government has stated its intention to repeal the HRA, replacing it with a British Bill of Rights and Responsibilities. Omitting the word 'human’ from the proposed Bill has concerned many supporters of the HRA, such as Amnesty International UK and Liberty, both of which have been campaigning to raise awareness that a change in the law could undermine the universality of human rights, allowing governments to pick and choose when they apply and to whom.

The fightback from these and other campaigners, such as senior lawyers and even MPs from the government benches, likely influenced the decision simply to detail proposals to introduce such a Bill in this May's Queen's Speech, rather than pursue full-blown legislation at this stage. It is hoped that this will allow for a lengthy consultation period permitting all ramifications to be fully thought through.

The rights that many regard as important, even taken for granted, in daily life need to be protected, particularly at times of economic hardship. Within our organisations, then, we need to ensure that the patients we serve are protected from both government policy and clinical decisions that may contravene the HRA. As Rachel Logan, Amnesty International UK’s legal advisor, reminds us:

“Governments are just made up of human beings, who are fallible, have opinions, make mistakes. You need to be able to hold them in check. The HRA helps you do that.”