A Detained Patient's Right to Visitors

Hello. Welcome to this mental health law training session from data low this session locks that are detained patients rights to visitors under the Mental Health Act. 1983. I'm Steph Barber on I'm a Consultant with Law Hound. I'm Retired Solicitor Andi I was previously a member off the law society's Mental Health Law Accredited panel. The session examines adult patients who are detained under the Mental Health Act 1983 or N. H. A. On their right to visitors, including the right to be able to communicate with friends and family on the telephone and through other means will also explore under what circumstances visitors can be restricted on the guidelines, which are issued to health care professionals. So let's start by looking at the right to be visited as you'll be aware. Article eight off. The European Convention on Human Rights requires public authorities to respect a person's right to a private life, subject only to some limited circumstances which will consider separately. Patients who are detained under the MH A are entitled to maintain contact with on be visited by almost anybody that they want to the Department of Health's code of practice to the MH A advises healthcare professionals to ensure that all patients have their right to maintain contact with family and friends and to be visited. However, it ISS more than simply complying with the law, since healthcare professionals recognise that maintaining contact with friends and relatives is a key element in a patient's care, treatment and recovery. Indeed, in order to meet a patient's needs, health care professionals are tasked with ensuring that individuals are able to meet visitors safely in private ANDI in conducive environments as well as to maintain private communication by telephone post Andi Elektronik Media Respecting the wishes of both patients and their visitors, and further that when an individual patient consents, if they have the capacity to give or refuse consent, of course Ah, patients nearest relative family carers advocates on others who know them should be actively encouraged in being involved in all aspects off the patient's care and treatment planning. Let's examine visits which must take place in private under the MH A if they so wish, patients have the right to see certain visitors in private, and these visitors include second opinion appointed doctors or so odes. Independent doctors approved conditions appointed to examine the patients in relation to an application or reference to the tribunal. People visiting on behalf off the Care Quality Commission or seek you see approved mental health professionals on independent mental health advocates or I am hate Che's. Therefore, there is, of course, of duty on healthcare providers such as hospitals to ensure that arrangements are in place to enable this to happen on that facility should also be extended to legal representatives. Of course, there could be situations where health care professionals are worried about the security off the visitor on if and when this happens. Then the duty is Onley healthcare professionals to discuss their concerns directly with the visitor so that suitable security arrangements can be made. And in fact, the code advises that visits should only be in clinical areas. Andi should be considered whether they need to be under supervision for both the safety of visitors and patients. So really, it's a balancing act between the right to privacy, but making sure that there is obviously a secure and safe environment for both the patient Onda, of course, the visitors. So having established that patients have a right to be visited, let's examine how arrangements are made for those visits on the duties placed on health care providers. Well, as the code advises, visit should be encouraged and made us comfortable and as easy as possible for both. Visitor on the patient on to ensure that visits and contacts can be maintained, ONDA contribute to a sense of respect for the patients entitlement to be visited. The code advises that in so far as is possible, patients should be placed in a hospital aske close as is reasonably practicable to their families. And if a patient is placed in another area than the needs, off families and carers who have to travel to visit must be considered. And so that means that visiting times must be reasonably flexible and comfortable and welcoming on where applicable child friendly visiting should take place in pleasant surroundings. On there should be access to facilities such as refreshments on, of course, in order to maintain contact on be able to organize visits, patients should have ready access to appropriate daytime telephone on Internet facilities and in fact, within the code is very much the emphasis on ensuring that the patient's rights are met. Andi also that the needs are met to promote effective treatment and care on making it all as easy as is possible. What about restricting ANDI excluding visitors to detained patients? Well, there is, of course, of duty on health care professionals and providers to ensure that patients are offered treatment and care in environments that are safe for the patients. The staff on any visitors on that those environments are both supportive and therapeutic, and so there's a duty to balance the rights and needs of patients with safety and security. So they're all circumstances when hospital managers may either restrict visitors, refused them entry or require them to leave, and therefore hospital managers should have a policy relating to the exclusion or restriction of patients, which should be available to patients, visitors, staff on health care professionals and so clearly displayed on the wards. There are two principal grounds which could justify the restriction or exclusion off a visitor, firstly, clinical grounds and secondly, security grounds. So let's examine restriction or exclusion on clinical grounds. It is possible for a patient's responsible condition to decide that some visits could be detrimental to the safety or well being off the patient. The visitor off the patients or staff on the ward. However, that decision should only be taken after the responsible condition has undertaken an assessment off the patient involved on then discussed. The situation with the rest of the team on a decision can be made to either restrict a visitor by making special arrangements for the visit or imposing reasonable conditions or excluding a visitor. The decision to exclude or restrict a visitor must be recorded in the patient's notes on subject to the normal considerations of patient confidentiality. Explain to both the patient and thieve visitor on wherever possible. The decision must be given with at least 24 hours notice. Visitors can also be restricted or excluded on security grounds and it is possible that a visitor may behave in a way which is or who's being destructive. Onda. The code provides examples off destructive behavior as incitement to abscond, smuggling off illicit drugs or alcohol into the hospital or unit, transfer off potential weapons unacceptable aggression. Onda attempts by member off the media to gain unauthorized access. And while exclusion is an option in these circumstances, it should still be as a last resort because it's a serious interference with the rights of the patients on are indeed, blanket restrictions could be considered a breach of patients. Article eight rights. Instead, the code advises that behavioural disturbance can be minimized by promoting a supportive and therapeutic culture within the care environment in which anti social behavior is anticipated, diffused, redirected on dso minimized. And therefore the code advises that a decision to exclude a patient should only be taken after other means to deal with problems have been considered on where appropriate. Tried having said that where there are exceptional circumstances, onda a visitor hasta be excluded. The decision, once taken, should be explained to the patient. It should also be communicated to the person being excluded again, subject to the normal considerations off patient confidentiality on any overriding security concerns, the decision must be fully documented. Andi. It should include full reasons for the exclusion. The written decision should them be made available for independent scrutiny by the Care Quality Commission, how old their representatives Onda hospital managers should review the effect on the patient off any decision which restricts any visits on. In fact, it's up to hospital managers to regularly monitor exclusions or restrictions of visitors to the hospital in relation to any detained patients. Let's examine the question off visitors, insofar as patients in seclusion are concerned, was seclusion is, of course, a restrictive intervention, which can be used to deal with disturbed patients as a part off medical treatment for mental disorder. Seclusion is Theseus revised confinement and isolation of a patient away from other patients on in an area of which the patient is prevented from leaving and where it is off. Immediate necessity for the containment off severe behavioural disturbance, which is likely to cause harm to others. Restricted intervention should always be a last resort on. There are safeguards in place to help avoid abuse so that seclusion has minimal impact on a patient's autonomy. The code recommends seclusion be applied flexibly on in the least restrictive manner possible, considering the patient's circumstances on therefore subject to suitable risk assessments. This flexibility should include allowing a patient to receive visitors will be that arrangements may be in place in terms of the safety off the patient, the visitors on the staff who may be involved. Let's examine visitors who are actually victims off the detained patient, often potential visitors are family carries or friends who are victims off a detained patient, but who still of course, wish to maintain contact with the patient. Andi. In these circumstances, there's a duty on the hospital or health care provider to balance the needs and rights off those individuals as victims of crimes, as well as in their role as family caress or friends on DSO reduced the risk of harm arising from contact with the patient. They're a minimum standards on right support and protection of victims of crime in any of their interactions with patients. Andi. Those are standards to which hospitals must a deer. Therefore, there's additional support, which should be available to help maintain contact but to also keep those victims safe. So let's consider the question of visitors being searched. Hospital managers should ensure that there's an operational policy on searching detained patients, which also extends to their belongings, surroundings and visitors on. That means that all patients vicious is on staff must be informed about the policy, and the information should be available in a variety of formats. Any searchers should only be conducted when they are clinically or operationally necessary on when other interventions are deemed to be inappropriate at the time, searches should be justified applying an objective test. That is whether the decision maker could reasonably have concluded that the interference off search was necessary. The code advises that searches should only take place when it's necessary for the safety, on protection, off the patient and or others. Or there is a suspicion that illicit substances, weapons or other prohibited items are being covertly conceals, or when staff have a suspicion that elicits substances, weapons or other prohibited items have been distributed to others. A search may be appropriate when a patient's history indicates that a search is required after, for example, returning from leave or when stolen property or valuables have been reported as missing on may be within the unit. A search may also be appropriate when staff have a suspicion that a patient is it significant risk of self harm or suicide on has concealed items that could be used for that self harm or suicide On Finally, a search might be justified if it's believed that visitors are bringing items, toothy wards or units that could be classed as unacceptable or contra bands. Searches of visitors would usually be confined to asking visitors to empty their pockets or bags. Having explained the reason behind the search initially and in fact, searches can only be carried out if he visitor consents. But whilst the situation is being explained to the visitor, the visitor must also receive an explanation that refusing to take part in the search on therefore not providing consent may mean that visiting rights are withdrawn. On door visits are supervised. If a visitor consent to a search on any prohibited or illegal items are found, then the ward manager or nurse in charge must decide whether visitors should either be refused entry or asked to leave the items with stuff in a safe identified area if appropriate. And of course, that depends on whether the item is an illegal item, such as an illegal substance, because if so, the visit shouldn't take place on the staff. Members should report the matter to the police for investigation. What about communications by letters and parcels? Well, starting point is that detained patients have the right to receive and send both letters and parcels. However, Section 134 subsection one of the MH A does enable healthcare providers to withhold, um, if one of the following circumstances apply so, firstly, that the person has requested that any communication addressed tooth um, by the patient should be withheld. And secondly, if the patient is detained in a high security psychiatric facility than the hospital manager may consider that the letter or parcel is likely to cause distress to the person to whom it's addressed, or any other person who is not a person on the hospital staff or, in fact, mike cause a danger to any other person where any mail is withheld, the patient does have the right to us. The CQ see to review the decision within six months off the date that the decision is taken. Onda under Section 134 subsection three. However, certain male can never be withheld from the patients on that includes mail from the quarter protection seek. You see advocates on the patient's legal advisers. What about communicating with visitors by telephone? While both the health care professionals and the code recognize that communication with family and friends is an integral part to a patient's care, and therefore, hospitals and other health care providers should make every effort to support the patient in making a maintaining contact with friends and family by telephone, mobile email or social media. However, this does need to be balanced with the potential for misuse. For example, a patient may make a nuisance calls Onda phones and devices with cameras and video and voice recording capability could potentially interfere with a confidentiality dignity on privacy of other patients. Stuff on visitors and this means hospitals and other health care providers should have a policy on the possession and use of mobile phones and electronic devices, both my patients, but also by visitors on. They need to also develop guidance on the use of social media. ONDA. Avoid a blanket restriction on the use off. Social media providers must also assess patients on the risk and appropriateness off a patients access to mobile phones, electronic devices and the Internet, etcetera Andi. In any event, patients should also be able to have access to a coin or card operated phone. If there are any restrictions, they should be fully documented on Gwen necessary. Whether it's a restriction, then alternative arrangements must be made, which still enable patients to making receive calls in privacy. So, for example, if a patient is being making nuisance calls, the patient should be able to make and receive calls in the ward office in an effort to restrict the amount of calls made but still allowing for privacy as the cold recognises. The principle that should underpin hospital award policies on all telephone use is that detained patients are not free to leave the premises, but that their freedom to communicate with friends and families should be maintained, a Sfar asses possible on restricted to the minimum extent necessary. And that brings us to the end of this session on Thank you for Joining me, Steph Barber.