Respecting family life on mental health ward for young people Reviewing and re-writing policies on mobile phone and internet use Expand The St Aubyn Centre is a Tier 4 service. Young people are admitted from all over the country, potentially separating them from their family and friends for many weeks. An ongoing problem for staff, common to many mental health in-patient services, has been managing access to mobile phones and the internet. There are additional concerns with young people around internet grooming, exploitation and inappropriate usage. This made staff fearful of being blamed for allowing such access and potentially placing a young person in a vulnerable position whilst in their care. This resulted in young people not having access to phones and the internet. Following their involvement in BIHR’s Delivering Compassionate Care project, St Aubyn applied a human rights approach and individualised care planning and have made the following changes: Mobile phones: previously the service policy banned young people’s use of mobile phones due to safety concerns (both harm to the young person or them using the phones for harm). The policy was reviewed and now all young people have access to their mobile phones, with safety concerns being managed on an individual basis, giving more responsibility to the young person. This has improved young people’s ability to maintain contact with their family and friends and provided staff with a framework for managing access issue. Internet access: this had also been restricted due to safety concerns. The service drafted a new policy, allowing young people access to the internet, with safety concerns being addressed by staff on an individual basis. The aim is to further improve young people’s contact with their family and friends, and gives staff a clear framework to respect rights and uphold their duties to protect against harm Example from BIHR's project Delivering Compassionate Care: Connecting Human Rights to the Frontline
Balancing people's right to privacy in residential settings Balancing right to respect for private life to help keep drugs out of housing units Expand “As a provider of mental healthcare and accommodation, St Martin of Tours Housing Association supports people with mental health issues and with offender backgrounds who need help to maintain their independence or to step down from secure hospital wards, prisons and similar situations. Prior to getting involved in BIHR’s project, we were very hands off about room searches, drugs and managing visitors. It was very liberating to find out that the right to respect for private life is a non-absolute right which can be balanced against the rights of others, prevention of crime etc. We’ve been able to use that framework to build room searches into residents’ care plans and help keep drugs out of the ‘projects’ (housing units). We also had a blanket ban on visitors going upstairs in our projects because some residents had a history of sexual offences. We’ve now used human rights to amend our policy and assess visiting on an individual basis, which allows us to balance safety against resident’s right to privacy.” Paul Holden, Operations Manager, St. Martin of Tours HA Ltd, from BIHR’s Delivering Compassionate Care project
Weighing up duty to respect vs duty to protect rights Early intervention team respect patient's autonomy Expand Practitioners at an early intervention psychosis team were working with a man with long-term mental health issues. The man had donated £6,000 to charity when a fundraiser knocked on his door. The practitioners were concerned whether the man had been financially exploited and didn’t know whether they should intervene to protect his well-being. The practitioners carefully considered this and, following training from BIHR, weighed up their duty to protect the man’s well-being against their duty to respect his autonomy (both protected by Article 8 of the Human Rights Act). A mental capacity assessment was arranged and it determined that the man did have capacity to make the decision to donate the money, he believed in the cause and it was important to him. The practitioners therefore decided not to intervene. However, they did alert the police to a possible issue in the area.
Amending care plan to respect family life Social worker uses HRA to ensure discharge plan is proportionate Expand A man had been detained in hospital under section 3 of the Mental Health Act and was discharged with an aftercare plan which included four home visits a day to support and monitor his mental health. He felt this was too much interference and refused his consent to the proposed plan suggesting instead one daily visit. Hospital staff were insisting on the four visits. A social worker from the Social Intervention Team had been trained by BIHR and recognised that this was about the man’s right to respect for family life. The social worker pointed out that the four visits would amount to a disproportionate interference with his right. It was then agreed that the plan would be amended to one visit per day.
Using rights to open up dialogue with other practitioners Respecting rights of patient with learning disability Expand “I had a client with learning difficulties who needed an operation. I was able to assist the doctors in thinking through all the human rights implications. I was able to show that it was not just about the right to life, but the broader impact of the procedures and the need to treat the patient in a way that respected her dignity. A human rights approach allowed me to open up a dialogue about how to carry out this operation in a less intrusive and less distressing way for the client.” Ged, Community Learning Disability Nurse, from BIHR’s Delivering Compassionate Care project.
Reduction in violent incidences in residential support Using a human rights approach to responding to physical/verbal aggression Expand St Martin of Tours Housing Association support people with mental health issues and with offender backgrounds who need help to maintain their independence or to step down from secure hospital wards, prisons and similar institutions. With an increasing number of complex referrals and residents exhibiting behaviours of concern, they applied to be a part of BIHR’s project to see if human rights could help change their philosophy of care. Following an incident in one of their ‘projects’ (housing units) where a member of staff was assaulted, they used human rights to review their internal policies and practices on dealing with violent behaviour. They are now recording incidences of physical and/or verbal aggression more closely, assessing people to ensure they are getting the mental health support they need, working more closely with the police and talking about this with residents and neighbours as a positive step to create a safe environment for well-being and recovery. As a result, violent incidences have been reduced by 50% and evictions are also down. “Using a human rights approach has helped change the character of the service and was a wonderful way to bring us back to focusing on human beings.” Paul Holden, Operations Manager, St. Martin of Tours HA Ltd, from BIHR’s Delivering Compassionate Care project
Rights-respecting best interests decisions Community learning disability nurse uses HRA framework to help make best interests decision Expand A community learning disability nurse used the Human Rights Act as a framework to help make a best interests decision. The nurse was supporting a woman with a learning disability who was experiencing severe pain from suspected gallstones. The person did not want a blood test and the nurse had to make a best interests decision about using restraint to allow the test. The nurse said: “I’m uncomfortable using restraint as it has been used to control people in the past but the Human Rights Act gave me the confidence to intervene, knowing that we were taking reasonable steps to protect the patient's right to life and right to be free from inhumane and degrading treatment and that we were using restrictions proportionate to the situation.” The nurse also challenged hospital staff on their decision to exclude the woman’s family from the best interests meeting using her right to private and family life. This made a real difference because the service-user had a close, trusting relationship with her brother and he was able to support her during the interventions, minimising the impact of restrictions on her physically and psychologically.
Dignified pathways in dementia care Dementia practitioner challenges care pathway using human rights Expand A dementia practitioner, Lisa, challenged poor practice around planning the care pathway of a client, following training from BIHR on how to use a human rights approach. Lisa recognised that the client’s own wishes to live in her own home were not being given appropriate weight. Lisa said: "getting people to think about the range of human rights involved meant she was given a much more dignified, respectful pathway to be supported to live in her own home". Lisa, Senior Dementia Practitioner, from BIHR's project Delivering Compassionate Care: Connecting Human Rights to the Frontline