‘Mental health sector at a crossroads’: taking the right path Having inspected all specialist mental health services in England, the Care Quality Commission (CQC) concluded that the mental health sector is ‘at a crossroads’. Whilst some services were excellent, the CQC also found poor care, as well as too much variation in quality of care and access to services. This raises the question: are mental health services respecting and protecting people’s human rights? The CQC’s report into the state of care in mental health services raises serious concerns, including: The safety of services: unsafe physical environments; inadequate staffing; and unsafe management of medicines Persistence of restrictive practices: too many locked wards; patients placed too far from home; risk of institutionalisation; and variation in use of restrictive practices and physical restraint Difficulty in accessing services and too long waiting times (although this could also be due to commissioners, rather than providers) Particularly concerning is the CQC’s warning that people using services could end up feeling ‘hopeless and powerless’ and fail to ‘fulfil their potential to regain control of how they live their lives’. This is flagged as a result of being institutionalised in locked wards where hospitals had failed provide the necessary high-quality, intensive rehabilitation care. As with all public services, mental health services have a legal duty to respect and protect people’s human rights. Under the Human Rights Act, this includes the right to liberty and the right to respect for private and family life, which includes wellbeing and autonomy. In the findings, the CQC flags one case in particular as a violation of human rights – a 17 year old was kept in a police cell for 78 hours because no bed was available in an inpatient service. In this case, the assistant chief constable wrote to the CQC flagging that this was ‘unlawful’ and amounted to a ‘violation’ of the right to liberty, as protected by Article 5 of the Human Rights Act. Road to success More positively, the CQC reports that the ‘vast majority of staff genuinely cared about the people who used their services’, with most services rated as good or outstanding for having caring and compassionate staff. We know from our work that human rights can support and empower managers and staff to deliver better care and make better decisions. Human rights can also transform the culture of an organisation and improve the service. We’ve been working with seven mental health and mental capacity service providers to embed human rights and ensure frontline staff have the knowledge and skills to fulfil the vital role they can play in upholding the dignity and human rights of the people using their service. For example, we supported St Martin of Tours to use a human rights approach to address violence and increase safety in their housing units – and violent incidences were reduced by 50%. Or when we first worked with St Aubyns (a CAMHS unit in Essex) the ward was on lock-down and had a blanket ban on mobile phones and internet. Using human rights, the service now takes a more proportionate response and uses individual risk assessments. Paul Hill, Clinical Manager said: “Using a human rights approach has revolutionised decision-making. It needs to be rights based, not just risk based.” We’ve produced 8 practical resources for practitioners on human rights and mental health/mental capacity, from early intervention to rehabilitation and services for children and young people (CAMHS). All these resources can be downloaded free of charge from our website. Human rights also empower people using services, so that they don’t feel ‘hopeless and powerless’ and can start to ‘regain control of how they live their lives’. This is why we have also produced practical resources for people using mental health and mental capacity services and their advocates, family members and carers. As a charity, BIHR is committed to empowering people and organisations to bring human rights to life. We support staff to put human rights at the heart of service delivery, or work with advocates to ensure people are treated with dignity and respect. Do get in touch with us to discuss how our training and consultancy services can assist you. Contact us on [email protected] or 0207 882 5850.