Siobhan was a patient in a mental health hospital in London. She had a history of self-harm and had attempted to take her own life in the past. Siobhan was under 24-hour observation, and was very distressed that she was not allowed to close the door to her room, or use the bathroom on her own.

This caused conflict with staff on the ward. Lisa, a nurse on the ward, felt under particular pressure, because management was very happy with the policy. They argued that it was working successfully and that the observation must continue in order to keep Siobhan safe. However, Siobhan became very angry with Lisa on several occasions and Lisa sometimes felt worried about her own safety.

Siobhan’s psychiatrist had assessed her on a number of occasions. She believed that Siobhan would attempt to harm herself again and might attempt to take her own life. The hospital had a duty to protect Siobhan’s life under Article 2 of the Human Rights Act for as long as her life was at risk, and she was in their care. However Siobhan’s psychiatrist also acknowledged that although the constant observation was being carried out to protect Siobhan’s life, it was an interference with her right to respect for private life (Article 8). This was causing her considerable distress, with potential implications for her recovery. Lisa’s right to respect for her private life would also be negatively affected if Siobhan did anything to harm her.

Siobhan’s advocate, who had worked with BIHR on an advocacy project, suggested that Siobhan and her treatment team meet to discuss these issues. Siobhan explained to her psychiatrist that being under 24-hour observation was causing her great anguish. She asked the treatment team to explain why she was under observation, and how long it would last. Once the team had done this, they worked with Siobhan to decide on some less intrusive measures that could be taken, that would still keep her safe. Together they agreed that she could close the door to the bathroom provided that she was searched first, with the door kept unlocked, while a nurse waited outside.

Being given the opportunity to express her feelings, and be part of the conversation about how her treatment could be changed, gave Siobhan much-needed comfort. Her relationship was also much better. Afterwards, Siobhan told her advocate that she could now see that the observation process was not a form of punishment, as she’d thought, but was instead designed to protect her human rights.