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A framework of rights
A new report from the Equality and Human Rights Commission has pointed to a number of deaths of people with mental health problems from non-natural causes whilst they were in custody, which it said were avoidable. It’s a distressing thought, and whilst the report is concerned with people who have been in custody (police stations, prisons, and detained in hospital under the Mental Health Act), I think some of its recommendations and its framework for preventing tragedies can be adopted in wider health and social settings. So, in this article I want to look at the framework that the EHRC used and see which of their messages could be adopted.
Focus on human rights
The Equality and Human Rights Commission is a public body appointed to promote human rights and equality. As you would expect, the context of this report is rooted in the various articles of the Human Rights Act 1998. Whilst this piece of law is never far from the news, it’s worthwhile reminding ourselves what it is about. The Human Rights Act is a piece of UK law drawn up in response to the European Convention on Human Rights which has been around since the end of the Second World War. The Act and the Convention incorporate a number of articles covering all aspects of human rights. The ones under scrutiny here were Article 2, which is the right to life, and Article 14 which seeks to avoid discrimination against people with mental health problems. The Human Rights Act places obligations on public authorities (and that would include care arrangements made by local authorities) to comply with those rights. The EHRC report maintains that if authorities were complying with these rights we would expect people will not be put at risk of losing their life, and that people will not get a worse care service because they have a mental health problem.
Lessons to be learnt
So what are some of the key recommendations arising from this inquiry?
- First we should listen to families. This has been a recurring theme through many inquiries. We should look beyond who might be listed as the person’s nearest relative. There may be family members and close friends who have useful information about the person that might contribute to an accurate assessment of risk.
- There needs to be adequate risk assessments undertaken on people in our care. There is no nationally recommended assessment tool, but there are many specialist risk assessment formats for the highest risk of service users. The important thing is not the format, it’s how comprehensive the assessment is, and that should look at not just statistical high risk groups, it should look at individual characteristics of the service users. The EHRC report highlighted the importance of trigger dates, such as the anniversary of a loved one’s death, and how that might be a factor in assessing suicide risk. Staff should be alert to other trigger factors, such as breaking bad news to someone.
- The other issue that the report focuses on is the importance of awareness of mental health problems. This means not just leaving it all to the experts; wherever people with mental health problems are in the care of others, such as in prison, it is important that staff are aware and alert to signs of someone’s mental health deteriorating. This is not about trying to be an expert, it is about knowing what warning signs are, and then making referral to the experts. Knowledge of the person is often as important as knowing about the type of their mental disorder.
- Sharing of information is important. We all know that, but it is the quality of the information that counts. The report talks about the use of mental health alerts on someone’s records, and how these can be very general. More information on the person’s particular mental disorder would be more useful.
A framework of rights
The ECHR report also encourages the use of what they call a human rights framework for protecting people in our care. The idea of the framework is that it can inform national and local policy, and can also be used as a checklist for organisations to see how they are performing. I believe this is a framework that can be adopted more widely than just for use in custody settings.
The framework involves staff looking at the following areas:
- Respect and dignity – these are fundamental good practice principles about treating people as we would wish to be treated. This part of the framework should be used to ensure service users are protected from harm from others.
- Risk assessment – this was one of the key factors in terms of deaths in custody. Not only is an individualised risk assessment important, but it needs to be revised regularly, and the assessment shared with those who need to know.
- Treatment and support – this is about ensuring people get the most appropriate treatment and support as soon as possible, and that that includes social support from family and other networks.
Not just a matter for mental health
Is there anything in this inquiry that is unique? Probably not, and just to reinforce that point the recently published inquiry report into the deaths at Furness General Hospital maternity unit has produced a list of recommendations, many of which could be very applicable to mental health. These include:
- Improve multi-disciplinary working so that vital information is shared, and avoid the dangers of teams closing in on themselves and operating a siege mentality.
- Ensure better quality assessment of risk.
- More training at all levels of the organisation, so that staff are clear about local and national guidelines in ways of working. Staff should always be trying to improve on the care that they provide.
- Use the experience of complaints as an opportunity to improve services – don't become defensive.
Both of these reports make very powerful reading. You can access it here.
The lessons are fairly straightforward – the crucial thing is to learn from them!