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Why our Human Rights Act a mental health nurse

Paul Hill is the Lead Nurse for Suffolk Children’s and Young Peoples Service in the Norfolk and Suffolk Foundation Trust. Paul has worked for the NHS for 27 years and is passionate about human rights within mental health services. He has been a  qualified mental health nurse for 21 years and has worked in a variety of different settings including Community based services and inpatients. Paul has worked across  Adult services , older peoples services and CAMHS. Paul has worked with BIHR in previous roles over the last 7 years and led on projects within CAMHS inpatient services, Memory assessment and dementia services and now CAMHS community services.

Please note, this is a guest blog and views expressed in this blog do not necessarily reflect the views of BIHR.

The Human Rights Act is embedded within everything we do in Mental Health services. They work intuitively within our governance and legal frameworks and inform our decision making in relation to individual care upwards towards service planning and transformation. They hold organisations to account and focus our intentions on what care we deliver.

Whoever we are, staff, service users, families and carers, we all have human rights, and these must be protected and upheld within all aspects of our work. Cultures develop within services when staff and services are under pressure. Sometimes when services are short of staff, care settings can look to identify ways of managing time more effectively, often at the expense of service users’ liberty or freedoms. We risk care becoming mechanical and task orientated rather than individual, and person centred. Holding the Human Rights Act in mind, helps us to avoid falling into this way of delivering care especially to those who are most vulnerable.

When a serious incident occurs, often the reactions of organisations is to restrict liberties and basic rights such as the right to a private life, in the interests of patient and staff safety. Restrictions upon items being brought into the wards and contact with families and friends can be restricted, often in the fear of another similar incident occurring. Security concerns within inpatient settings can result in doors being looked to prevent access from the public, yet patients who are informal and are free to leave the ward at any time, are required to ask permission to leave. Access to the internet or mobile phones can be restricted in fear of the potential for grooming, exploitation or requesting access to contraband items and harmful substances such as drugs or items that can be used to self-harm.

All of these things are done with good intentions. As a nurse, you want to care for your patients yet in doing so you can risk becoming paternalistic and want to protect rather than empower. Teams can do the same, responding to such events by imposing blanket restrictions to safeguard those they care for. The systems we have in place to protect those in our care can become so risk focused that the challenge for front line practitioners is that the impact of protecting individuals can soon develop into blanket restrictions and polices. The Human Rights Act is there to remind us that the individual needs to be behind every decision that is made. Their illness, family, wishes, beliefs and cultural backgrounds are unique to them and a restrictive policy that prevents risk, does not fit all people, there has to be flexibility and compromise.  When we think about the language we use in health care settings, it acts almost as a furniture of separation, separating us from individual care–  safeguarding, risk management, restraint. All necessary components of care and safety, but they have to be used within the context of human rights. Health care services use the Human Rights Act to offer a compromise – offering safe care that does not inhibit someone’s right to a family life. A good example of this is the adoption of a mobile phone policy that allows all patients access to a phone so that they can remain in contact with family and friends. To protect the patient from possible harm as noted above, an agreed care plan could be utilised to manage this safely which may include a phone that cannot access the internet. This can then be adopted on an individual basis rather than a blanket approach of an outright ban of phones for patients in mental health wards.

The Human Rights Act matters to me because it puts services users at the heart of everything we do – we should always be asking the question about patient safety alongside what is in the best interests of that individual, what that person wants, is that what they need, what do they think, how would you like to be treated in a similar situation. Using a rights-respecting approach, supports practitioners to hold the Human Rights Act in mind when we deliver care and this enables patients to be safe from harm without using a blanket restrictions.

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