Mental Health Accommodation Support: making human rights everyone's job Paul Holden, Operations Manager at St Martin of Tours, reflects on using human rights in practice My name is Paul Holden, I am the Operations Manager with St Martin of Tours (St Martins’) Housing Association which is a provider of accommodation based services in London for people experiencing mental illness, learning disabilities and who may have forensic histories. We are currently helping around 100 people with complex support needs to live independently within the community. For over 30 years St Martins’ (and before this as the Catholic Fund, a charity that helped homeless and destitute men) has supported people on the margins of society, those whose basic human rights have been undermined. However, it has only been over the last three years that St Martins’ has taken a more informed and systematic approach to address and redress the human rights challenges that are experienced by those vulnerable people that use our services. This has been achieved via working in partnership with the British Institute of Human Rights. Changing our approach Over the past three years St Martins’ has progressed from a philosophical commitment to human rights to a greater actualisation of such intentions within its day to day practice. Staff now see it as their responsibility to identify human rights concerns and report these to their managers as incidents. Previously staff may have been less inclined to do so, believing that human rights was a matter only for people in the higher levels of the organisation whose job it is to establish policy frameworks and promote a certain organisational culture. Challenges Initially we found that a small number of staff had internalised a rather negative concept of human rights, possibly due to negative media attention and sensationalised cases. This was overcome through the training that BIHR provided that focussed upon human rights as UK law and upon the duties that it places upon agencies like St Martins’ to provide health and social care in a way that does not contravene human rights and which upholds and enhances good practice. Embedding a human rights approach Working with BIHR helped us to identify the areas within the Human Rights Act that were the most relevant for us as a health and social care provider, which were the right to life (protected by Article 2 in the Human Rights Act), the right to be free from inhuman or degrading treatment (Article 3), the right to liberty (Article 5) and the right to respect for private and family life (Article 8). The training that we received was of very high calibre. It helped staff to understand the difference between absolute human rights and restricted human rights and how to think in terms of balancing competing human rights when faced with practice dilemmas. The programme with BIHR also helped staff to more confidently work with the Mental Capacity Act, and how it relates to the Human Rights Act, to understand when a perceived duty of care should give way to respecting and upholding a lifestyle choice (protected by Article 8). The nature of St Martins’ though is that people working within our projects (housing units) often leave within 2-3 years to further their professional careers. Therefore in order to achieve ongoing positive action as an organisation we have had to endeavour to do find a way to establish a human rights respecting culture more deeply within the customs and practices of the organisation. This we are addressing by including human rights explicitly within our Quality Framework. We now ask ourselves the question: Do we uphold the statutory rights of people (Human Rights, Equalities, Citizenship, MCA, MHA, etc.)? To achieve this standard we are placing human rights alongside safeguarding in our mandatory training for all staff. We have also created an incident reporting category for Human Rights Concerns so that staff can report any such concerns simultaneously to their colleagues and managers so that these can be investigated and responded to appropriately. Taking positive action As well as having improved our assessment and support planning procedures so that they are more solid in respecting human rights we are now also exercising our positive duty to protect human rights more effectively. We are now seeing a range of human rights issues being flagged up that may otherwise have gone by and been unattended to. Recent examples include: staff raised a concern over the positioning of a CCTV camera where people are likely to cross a communal area to and from a shower room in a state of undress believing that they are not being observed staff raised concerns when an agency care worker entered a resident’s room without knocking first when this was neither permitted nor agreed under the individuals support plan we have confidently resisted requests from a group of neighbours for our staff to wear high visibility (fluorescent) jackets when supervising our residents in the neighbourhood. In broader terms we have also used a human rights approach to respond more swiftly and in partnership with the police and safeguarding teams, when it is clear that residents are unsafe in their placement due to the violence or harassment by another. We have consequently seen a marked reduction in the level of serious incidents within our projects (housing units). What’s next? We would like to continue to improve our move-in (transition) process from hospitals as we are aware that the immense pressure on hospital beds can create a situation where people are given very little choice about where they move to, being effectively ‘out-paced’ by hospital discharge systems. We are keen to protect the right of people to make positive choices about moving into our projects (protected by Article 8), believing that there is a correlation between people being fully included in this decision and the success of their placement that follows. My take on human rights I have come to see human rights compliance as a fundamental standard needed to provide effective services to people on the margins of society who, due to social and economic factors such as stigma and the demands upon public funds, could end up with services that are actually doing such people more harm than good.