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human rights of mentally ill

human rights of mentally ill

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Published by Shyam

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Published by: Shyam on Sep 12, 2009
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HUMAN RIGHTS OF MENTALLY ILLIn 1973 the American Hospital Association (AHA) issued a patient’s rightsthat many hospitals and community based settings have adopted. These rights werereaffirmed in 1990. In 2003 this document evolved into “The Patient CarePartnership: Understanding Expectations, Rights, and Responsibilities”. Thisdocument is often given to patients on admission and read or explained to them.The psychiatric patients currently have the following rightsRight to communicate with people outside the hospital throughcorrespondence, telephone, and personal visitsRight to wear clothing and personal effects with them in the hospitalRight to religious freedomRight to be employed if possibleRight to manage and dispose of propertyRight to execute billsRight to enter into contractual relationshipsRight to make purchasesRight to educationRight to habeas corpusRight to independent psychiatric examinationRight to civil service statusRight to retain licences, privileges, or permits established by law, such asa driver’s or professional licenceRight to sue or be suedRight to marry and divorceRight not to be subject to unnecessary mechanical restraintsRight to periodic review of statusRight to legal representationRight to privacyRight to informed consentRight to treatmentRight to refuse treatmentRight to treatment in the least restrictive settingSome of these rights deserve a more thorough discussion.Right to Communicate With People Outside the HospitalThis right allows patient to visit and hold telephone conversations in privacy andsend unopened letters to anyone of their choice, including judges, lawyers,families, and staff. Although the patient has the right to communicate in anuncensored manner, the staff may limit access to the telephone or visitors when itcould harm the patient or be a source of harassment for the staff. The hospitalalso can limit the times when telephone calls are made and received and whenvisitors can enter the facility.Right to Keep Personal EffectsThe patient may bring clothing and personal items to the hospital, taking intoconsideration the amount of storage space available. The hospital is notresponsible for their safety, and valuable items should be left at home. If thepatient brings something of value to the hospital, the staff should place it inthe hospital safe or otherwise provide for maintaining a safe environment andshould take dangerous objects away from the patient if necessary.Right To Enter Into Contractual Relationships
The court considers contracts valid if the person understands the circumstances ofthe contract and its consequences. Once again, a psychiatric illness does notinvalidate a contract, although the nature of the contract and degree of judgementneeded to understand it are influencing factors.Incompetency. Related to this right is the issue of mental incompetency. To proveincompetence in court, all of the following must be shown:The person has a mental disorder.This disorder cause a defect in judgement.This defect makes the person incapable of handling personal affairs.The psychiatric diagnosis of the patient is not important. If a person isdeclared incompetent, the court will appoint a legal guardian to manage his or heraffairs. If ruled incompetent, a person cannot vote, marry, drive, or makecontracts.Right to EducationMany patient exercise the right to education on behalf of their emotionally ill ormentally retarded children. The U.S. Constitution guarantees this right toeveryone, although many states have not provided adequate education to allcitizens in the past and are now required to do so.Right to Habeas CorpusHabeas corpus is an important constitutional right patients retain in all stateseven if they have been involuntarily hospitalized. It provides for the speedyrelease of any person who claims to be detained illegally. A committed patient mayfile a writ at any time on the grounds of being sane and eligible for release. Thehearing takes place in court, where those who wish to restrain the patient mustdefend their actions. Patients are discharged if they are judged to be sane.Right to PrivacyThe right to privacy implies the person’s right to keep some personal informationcompletely secret or confidential. Confidentiality involves the nondisclosure ofspecific information about a person to someone else unless authorized by thatperson. Every psychiatric professional is responsible is responsible forprotecting a patient’s right to confidentiality, including even the knowledge thata person is in treatment or in a hospital. Revealing such information might resultin damage to the patient. The protection of the law applies to all patients.The Health Insurance Portability and Accountability Act (HIPAA,2003) is the firstcomprehensive privacy protection act which guarantees patients four fundamentalrights related to the release of information:1.To be educated about HIPAA privacy protection2.To have access to their own medical records3.To request correction or amendment of their health information to which theyobject4.To require their permission for disclosure of their own personalinformation.Right to Informed ConsentThe goal of informed consent is to help patients make better decisions. Informedconsent means that a clinician must give the patient a certain amount ofinformation about the proposed treatment and must attain the patient’s consent,
which must be informed, competent, and voluntary.Information to be Disclose in Obtaining Informed ConsentDiagnosisDescription of the patient’s problemTreatmentNature and purpose of the proposed treatmentConsequencesRisks and benefits of the proposed treatment including physical and psychologicaleffects, costs, and potential resulting problemsAlternativesViable alternatives to the proposed treatment and their risks and benefitsPrognosisExpected outcomes with treatment, with alternative treatments, and withouttreatment.In obtaining informed consent the clinician should adhere to theprinciples listed above.Right to TreatmentEarly court cases extended the right to treatment to all mentally ill and mentallyretarded people who were involuntarily hospitalized. The courts defined threecriteria for adequate treatment:1.A humane psychological and the physical environment2.A qualified staff with a sufficient number of members to administer adequatetreatment3.Individualized treatment plansMost important is the requirement for an individualized treatment plan.Failure to provide it means that the patient must be discharged unless he or sheagrees to stay voluntarily. Failure to provide it means that the patient must bedischarged unless he or she agrees to stay voluntarily.Right to Refuse TreatmentThe relationship between right to treatment and right to refuse treatment iscomplex. The right to refuse treatment includes the right to refuse involuntaryhospitalization. It has been called the right to left alone.The involuntary therapy conflicts with two basic legal rights: freedom of thoughtand the right to control one’s life and actions as long as they do not interferewith the rights of others.Right to Treatment in the Least Restrictive SettingThe right to treatment in the least restrictive setting is closely related to theright to adequate treatment. Its goal is evaluating the needs of each patient andmaintaining the greatest amount of personal freedom, autonomy, dignity, andintegrity in determining treatment. This right applies to both hospital-based andcommunity programs. Another consideration in the least restrictive alternative isthat it applies not only to when a person should be hospitalized but also to how aperson is cared for. It requires that a patient’s progress be carefully monitored

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