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HUMAN RIGHTS OF MENTALLY ILL

In 1973 the American Hospital Association (AHA) issued a patient’s rights


that many hospitals and community based settings have adopted. These rights were
reaffirmed in 1990. In 2003 this document evolved into “The Patient Care
Partnership: Understanding Expectations, Rights, and Responsibilities”. This
document is often given to patients on admission and read or explained to them.

The psychiatric patients currently have the following rights

• Right to communicate with people outside the hospital through


correspondence, telephone, and personal visits
• Right to wear clothing and personal effects with them in the hospital
• Right to religious freedom
• Right to be employed if possible
• Right to manage and dispose of property
• Right to execute bills
• Right to enter into contractual relationships
• Right to make purchases
• Right to education
• Right to habeas corpus
• Right to independent psychiatric examination
• Right to civil service status
• Right to retain licences, privileges, or permits established by law, such as
a driver’s or professional licence
• Right to sue or be sued
• Right to marry and divorce
• Right not to be subject to unnecessary mechanical restraints
• Right to periodic review of status
• Right to legal representation
• Right to privacy
• Right to informed consent
• Right to treatment
• Right to refuse treatment
• Right to treatment in the least restrictive setting
Some of these rights deserve a more thorough discussion.

Right to Communicate With People Outside the Hospital

This right allows patient to visit and hold telephone conversations in privacy and
send unopened letters to anyone of their choice, including judges, lawyers,
families, and staff. Although the patient has the right to communicate in an
uncensored manner, the staff may limit access to the telephone or visitors when it
could harm the patient or be a source of harassment for the staff. The hospital
also can limit the times when telephone calls are made and received and when
visitors can enter the facility.

Right to Keep Personal Effects

The patient may bring clothing and personal items to the hospital, taking into
consideration the amount of storage space available. The hospital is not
responsible for their safety, and valuable items should be left at home. If the
patient brings something of value to the hospital, the staff should place it in
the hospital safe or otherwise provide for maintaining a safe environment and
should 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 of
the contract and its consequences. Once again, a psychiatric illness does not
invalidate a contract, although the nature of the contract and degree of judgement
needed to understand it are influencing factors.

Incompetency. Related to this right is the issue of mental incompetency. To prove


incompetence 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 is
declared incompetent, the court will appoint a legal guardian to manage his or her
affairs. If ruled incompetent, a person cannot vote, marry, drive, or make
contracts.

Right to Education

Many patient exercise the right to education on behalf of their emotionally ill or
mentally retarded children. The U.S. Constitution guarantees this right to
everyone, although many states have not provided adequate education to all
citizens in the past and are now required to do so.

Right to Habeas Corpus

Habeas corpus is an important constitutional right patients retain in all states


even if they have been involuntarily hospitalized. It provides for the speedy
release of any person who claims to be detained illegally. A committed patient may
file a writ at any time on the grounds of being sane and eligible for release. The
hearing takes place in court, where those who wish to restrain the patient must
defend their actions. Patients are discharged if they are judged to be sane.
Right to Privacy

The right to privacy implies the person’s right to keep some personal information
completely secret or confidential. Confidentiality involves the nondisclosure of
specific information about a person to someone else unless authorized by that
person. Every psychiatric professional is responsible is responsible for
protecting a patient’s right to confidentiality, including even the knowledge that
a person is in treatment or in a hospital. Revealing such information might result
in damage to the patient. The protection of the law applies to all patients.
The Health Insurance Portability and Accountability Act (HIPAA,2003) is the first
comprehensive privacy protection act which guarantees patients four fundamental
rights related to the release of information:
1. To be educated about HIPAA privacy protection
2. To have access to their own medical records
3. To request correction or amendment of their health information to which they
object
4. To require their permission for disclosure of their own personal
information.

Right to Informed Consent

The goal of informed consent is to help patients make better decisions. Informed
consent means that a clinician must give the patient a certain amount of
information 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 Consent

Diagnosis
Description of the patient’s problem

Treatment
Nature and purpose of the proposed treatment

Consequences
Risks and benefits of the proposed treatment including physical and psychological
effects, costs, and potential resulting problems

Alternatives
Viable alternatives to the proposed treatment and their risks and benefits

Prognosis
Expected outcomes with treatment, with alternative treatments, and without
treatment.

In obtaining informed consent the clinician should adhere to the


principles listed above.

Right to Treatment

Early court cases extended the right to treatment to all mentally ill and mentally
retarded people who were involuntarily hospitalized. The courts defined three
criteria for adequate treatment:
1. A humane psychological and the physical environment
2. A qualified staff with a sufficient number of members to administer adequate
treatment
3. Individualized treatment plans
Most important is the requirement for an individualized treatment plan.
Failure to provide it means that the patient must be discharged unless he or she
agrees to stay voluntarily. Failure to provide it means that the patient must be
discharged unless he or she agrees to stay voluntarily.

Right to Refuse Treatment

The relationship between right to treatment and right to refuse treatment is


complex. The right to refuse treatment includes the right to refuse involuntary
hospitalization. It has been called the right to left alone.
The involuntary therapy conflicts with two basic legal rights: freedom of thought
and the right to control one’s life and actions as long as they do not interfere
with the rights of others.

Right to Treatment in the Least Restrictive Setting

The right to treatment in the least restrictive setting is closely related to the
right to adequate treatment. Its goal is evaluating the needs of each patient and
maintaining the greatest amount of personal freedom, autonomy, dignity, and
integrity in determining treatment. This right applies to both hospital-based and
community programs. Another consideration in the least restrictive alternative is
that it applies not only to when a person should be hospitalized but also to how a
person is cared for. It requires that a patient’s progress be carefully monitored
so that treatment plans are changed based on the patient’s current condition.

Role of Nursing

The National League for Nursing (1977) issued a statement on the nurse’s role in
patient’s rights. The league urged nurses to get involved in ensuring patient’s
human and legal rights.
The league identified many of the previously mentioned rights, plus the following:

• Right to health care that is accessible and meets professional standards,


regardless of the setting
• Right to courteous and individualized health care that is equitable, humane,
and given without discrimination based on race, colour, creed, sex, national
origin, source of payment, or ethical or political beliefs
• Right to information about their diagnosis, prognosis, and treatment,
including alternatives to care and risks involved
• Right to information about the qualifications, names, and titles of health
care personnel
• Right to refuse observation by those not directly involved in their care
• Right to coordination and continuity of health care
• Right to information on the charges for services, including the rights to
challenge these charges
• Above all, the right to be fully informed about all their rights in all
health care settings.
Perhaps the most important factor in ensuring patient’s rights are the
attitude, knowledge, and commitment of the mental health professional.