Hello. Welcome to this mental health Law session from Data Law. This session is about the Mental Health Act in 1983 on Detention and the Right to Dignity. Onda Respect I'm Steph Barber on I'm a retired solicitor from Law Hound Limited. Andi I was formerly a member off the Law society's accredited panel. In respect of mental health law in this session, we're going to be considering a patient's right to dignity and respect whilst being detained under the Mental Health Act 1983 or the N H. A. And in particular, we're going to look a two aspects personal and property searchers on blanket policies. We've got to consider a patient's right to dignity and respect against the background of human rights generally. And, for example, Article eight off the European Convention on Human Rights, which requires public authorities to respect a person's right to a private life on the Department of Health of Produced a Mental Health Act 1983 Code of practice. All the code which aims to safeguard patients rights on comply with the law on, must be considered by health and social care professionals. The code is used by patients in hospital on those in the community, their families carer on advocates to the code is there to help make sure the turning one experiencing mental disorder on being treated under the act gets the right care, treatment and support on Does. That code advises privacy, safety and dignity are important constituents off a therapeutic environment on therefore, healthcare professionals are advised to make a conscious effort to respect the privacy and dignity of patients. Ast faras It's possible whilst maintaining safety, and this extends to such aspects of life. Is enabling a patient to wash and dress in private to be able to send and receive mail, including emails without restriction, facilitating patients to meet or communicate with people of their choosing in private, including within their own rooms on the protection of their private property. And of course, this is against the background of the Equality Act aspect on the need to avoid discrimination. As the code advises, people taking decisions under the act must recognize and respect the diverse needs, values and circumstances of each patient, including their age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity race, religion or belief, sex and sexual orientation. on culture on this means that the patient's care plans all the equivalent should take into account the individual, including any disabilities. Ah, patients, level of cognitive functioning, the impact of age in terms of psychological and emotional maturity, the patient's ethnicity, culture, religion or belief, gender, gender, identity and sexual identity. And they should also maximize privacy and dignity. What about empowering and involving each patient? Well, the heart, the code and care planning is the need to ensure that each patient is empowered and given the opportunity to be involved in the planning, developing on reviewing off their own care and treatment to help ensure that it's delivered in a way that's is appropriate and is effective for them as is possible. And so this means that wherever is reasonably possible, care plans should be produced in consultation with the patient. Patients should be enabled to participate in decision making a Sfar as they're capable of doing so on. That means considering providing the necessary information, help and support to do so. A patient's views past and present wishes and feelings, whether they're expressed at the time or in advance, should also be considered a Sfar as they're reasonably ascertainable patient choices and views should be fully recorded if a decision is made that goes against those than those reasons must be given transparently explained to them on fully documented. And finally, patients should be able to access the support of family and caress should they wish to do so as well as being made aware of their right to access on independent mental health advocates or, in I am a check for additional support. So what should health care professionals be doing in practiced to help insure a patient's dignity and respect? The code makes it very plain that each hospital needs to have a very clear privacy and dignity policy on, of course, the accompanying procedure with appropriate and relevant stuff training. And there's guidance with regards the policy, which needs to deal with such aspects as ensuring that patients have every opportunity to maintain contact with families and friends by telephone on their four hospitals need to ensure that policies are there for the use of mobile phones on computing devices. Policies also need to cover such items a segregated sleeping on bathroom facilities to protect the needs of patients of different genders and of course, transgender patients on the policy needs to ensure that the nature of engagement with patients onda therapeutic environments on the structure own quality of life on the ward is such to encourage patients to remain in the ward on minimizing a culture off containment. And of course, there is also, in practice the need to maintain security, so privacy and dignity and respect need to be balanced against security. On there are particular areas which can cause concerns and issues such as, for example, conducting personal other searches on blanket restrictions. Let's have a look at conducting personal and other searches. All hospitals should have a clear and operational policy regarding searches of both people and property, which should be clearly displayed on communicated to patients in a format and language that they will understand. It goes without saying that all stuff need to be trained on the policy on, of course, the relevant processes. The policy needs to be based on the following principles. Firstly, that the intention is to create and maintain a therapeutic environment in which treatment may take place on to ensure the safety of the premises on the safety of patients and staff. Secondly, searching should be proportionate to the identified risk and should involve the minimum possible intrusion into the individual's privacy. Thirdly, all searches should be undertaken lawfully on with due regard to respect for the person's dignity and privacy. And finally, whilst routine and runs. I'm searching without cause can be carried out on detained patients without their consent. It should only be in exceptional circumstances. Andan example off in exceptional circumstances when such a search might be necessary, is if patients are detained in a particular unit, which means they tend to have dangerous or violent propensities on means they create a self evident pressing need for additional security Before conducting a search. Healthcare professionals should firstly inform the person about what's happening on why it's happening in a way that they can understand. Andi. This information needs to include the fact that they don't have to consent. This requires the healthcare professional, of course, to take into account the specific needs of the individual to make sure that they understand the information. So, for example, taking to account the needs of those with impaired hearing or a learning disability or Children, a young people or the need for the use of an interpreter. And of course, this is particularly important when there's a potential lack of capacity Onda before conducting a search. They also need to seek valid consent valid in the consent needs to be informed on can't be given by means of threat, intimidation or inducements. When the patient consents to the search, the search should be carried out, ensuring the maximum dignity and privacy off the person. On this means searches should only be undertaken by staff who have received specific training. To do so, searches should respect gender, culture and faith on this should be same sex searches wherever possible on where that's really not possible. There should be at least two healthcare professionals presence. There needs to be a respect for patients. And so, for example, personal searches shouldn't take place in a public area unless there are, of course, exceptional circumstances. And very importantly, the patient needs to be kept informed throughout the whole process. On That's information, of course, in a way that particular individual patients can understand, and after the search, there should be a comprehensive record capped, including the reasons for the search on details of any consequent risk assessment where any belongings are removed. The patient must be given receipt for thumb and told where the items will be stored on when they're going to be returned on. This should be support provided for both patients and staff affected by the process off searching particularly, for example, searches which take place without consent, or the use of physical intervention on its up to hospital managers to ensure searches are audited and regularly reviewed. What about conducting searches without consent? Well, the code accepts that there may be certain circumstances when it may be necessary to search a detained patient all their possessions without their consent. However, if a detained patient refuses consent or lacks capacity to decide whether or not to consent to the search than the Patients responsible commission or phoning that, another senior condition with knowledge of the patient's case should be contacted without delay. If it's practicable to see if there's any clinical objection to searching by force Andi relevant hospitals own policy should cover situations for dealing with and resolving any disagreement or dispute where there's a clear clinical objection to a search. In any event, the patients should be informed about what is happening on why it's happening and in a way that that patient can understand. The patient should be kept under close observation on separated but not secluded, and searches can be carried out without consent if there are no clinical objections. Andi, it's considered to be necessary, but there must be a post incident review after every search undertaken without the person's consent. Of course, in terms of searches, the question of maintaining security is relevant. Searches shouldn't be delayed if there's reason to think that the patient is in possession of anything which night pose an immediate risk, either to their own safety or that of anyone else. But any force should be kept to the minimum necessary on differ. Patient physically resists being personally searched. Physical intervention should normally only proceed on the basis of a multi discipline reassessment unless it is urgently required. Let's take some in Blunkett policies and restrictions. Blanket policies are inflexible policies or rules which restrict a patient's liberty. Andi other rights, which routinely apply to all patients or two classes of patients within the service without individual risk assessments to justify their application. As the code advises, blanket restrictions would include restrictions concerning access to the outside world, access to the Internet or access to or banning mobile phones and charges incoming or outgoing mail, visiting hours, access to money or the ability to make personal purchases or taking passed in preferred activities. The code takes quite a robust view on the face of it in relation to blanket restrictions, advising healthcare professionals that they have no basis in national guidance or best practice. And they promote neither independence nor recovery on, in fact, might breach a patient's human rights. They advised that they should be avoided unless they can be justified as necessary on proportion responses to risks identified for particular individuals. But they must never be used to punish or humiliate, but only ever is proportionate and measured responses to and individually identified risks on they should never be applied for longer than could be shown as necessary. So can blanket restrictions ever be justified? Well, as the cold points out healthcare professionals, except that there may be certain secure situations where there is need for enhanced security in order to manage high levels of risk to other patients, stuff on members off the public. However, even in those situations, individual patients needs should be assessed on restrictions based on security needs off the identified risk. Where a patient doesn't need those security restrictions, they should be relaxed where overall security will not be compromised. In cases where security will be compromised, the healthcare professionals should ask themselves, Is this the best environment for that individual patients? Healthcare professionals must consider whether there's an alternative available with less security. Andi. In fact, blanket restrictions must only impose the least restriction possible on DNO. Form of blanket restriction should be implemented unless the hospital managers have expressly authorized it on the basis off the organization's policy and subject to local accountability on governance arrangements and therefore, before imposing any blanket restriction, health care professionals should assess and consider the impact of a blanket restriction on the individual patients concerned on, then documented in the patient's own records. Well, what about a blanket locked door policy? Well, this type of policy is likely to mean a restriction on patients, right Article eight or a deprivation of liberty impacting on all patients in a particular ward or hospital on this means that blanket locked or policies should only impose proportionate restrictions on contact with family and friends, which could be justified as being in the interests of the health and safety of the patient or others. So, for example, patients shouldn't be locked in clinical areas simply because is inadequate. Staffing ONDA Any policy should conform to the empowerment and involvement guiding principles into forest patients. Concerns on the local policies for locking clinical areas should be clearly displayed, unexplained each patient on admission on before imposing a locked door policy any health care professionals must consider the alternatives are available. So, for example, the safety of informal patients who will be at risk of harm if they wandered out of a clinical environment. It will should be insured by adequate stuffing levels. Positive therapeutic engagement on good observation, not simply by locking the doors of the unit or ward on before imposing a locked door policy. Healthcare professionals also need to consider how to reduce the negative psychological on behavioral effects of having locked doors, whether or not patients are formally detained. And, of course, they need to consider the impact on the patients on make sure that this is documented within the patient's own records. What about inform patients well informal patients who have the mental capacity could consent to admission on DSO two remaining on the ward or in the hospital. However, it's clear that even in these circumstances, on informal patient must be fully informed about a locked door policy on its implications, including clarity after their ability to leave it any time on the process for leaving the ward or hospital. So, for example, who to speak to or what they need to do unless, of course, they become detained under the Mental Health Act. And so, for example, the impact of Section five holding powers also needs to be clarified for those patients in terms of dignity and respect. Is the Mental Health Act still fit for purpose? Well bearing in mind the 1983 date off the Mental Health Act on although There Have Bean Amendments. In June 2000 and 17 the Mental Health Alliance published a report which concluded that the Mental Health Act was not fit for purpose, particularly so far. Dignity and respect is concerned. They cite, for example, the fact that the MH A relies on the nearest relative rather than the next of kin being involved in the patient's care and treatment on felt that this was somewhat outdated and didn't actually promote dignity. On respect into faras, most patients were concerned. The key findings show that 49% of respondents disagreed that people are treated with dignity under the Mental Health Act on 50% said that they would not be confident that their human rights would be protected under the Mental Health Act if they were detained under it. Whilst the reports has been presented to the government, we have not yet had any formal feedback the Mental Health Alliance report is available to download online on. You'll see the Link onscreen now Andi in your notes and it's certainly worth reading through the full report as and when you are able. And that concludes this session from Data Law. Thank you so much for joining me. Steph Barber on the session.
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