A Human Rights Based Approach to Mental Health Care

Human rights stands at the heart of social work, and from its very beginnings social work has been …a human rights profession.” (Hall 2017)

Human rights within adult mental health are enshrined in the 2006, Convention on the Rights of People with Disabilities (CRPD). Ireland signed the Convention in 2007 and further to its ratification in March 2018. This in turn led to the Convention coming into recognition from April 2018. The CRPD employs recognized human rights principles from the United Nations Declaration on Human Rights (UNDHR) to the situation of people with disabilities. Both Equality Acts (Employment Equality Acts, 1998-2015, and the Equal Status Acts 2000-2015), define a disability as, ‘a condition, disease or illness, which affects a person’s thought process’.  Similarly, the Disability Act 2005, in its definition of a disability, includes ‘mental health’ as a perquisite of a disability. Added to the CRPD, this essay will also highlight the service user’s rights under the Mental Health Act, 2001 (MHA 01) and take a brief look at A vision for change (AVFC 2006) to investigate its implementation. The essay will also underpin how a human rights based approach to the following scenario could have been achieved.

This incident took on the psychiatric ward in Connolly Hospital, Blanchardstown. Ken, an involuntary patient had recently been admitted onto the ward. Ken had a diagnosis of Schizophrenia, and was a regular in-patient on the psychiatric ward. During my final multi-disciplinary meeting (MDT), it was noted that Ken had, over the weekend, been observed ‘walking rapidly from his bedroom to the nurse’s station’ and seemed to be in a lot of distress. The decision was made to increase Ken’s medication, therefore leaving Ken very sedated. There was uncertainty regarding whether or not consent was provided by Ken for the increase in medication. Over the weekend the locum consultant psychiatrist, who was from the United Kingdom (UK), had administered the increase in Kens medication. The locum consultant psychiatrics was currently back in the U.K. and therefore unable to give an account for his actions. After the MDT, I began questioning human rights concerns surrounding this incident. Issues relating to consent, will and preference, autonomy and self-determination were to the forefront of my questioning stance. As this incident occurred on my last week of placement, the outcome is unknown as the matter was being investigated further.

Adopting a human rights based approach in mental health involves employing an emphasis not only on evading human rights abuses but making sure that human right principles are the core element of the service-providing organisation (Curtice & Exworthy 2010).

When reflecting back on this incident, the first issue that concerned me related to matters surrounding best interests and consent. Under Part 1, Section 4 MHA 01, the best interests of the individual should be the principle consideration. Service user’s rights must be respected, including their right to dignity, bodily integrity, privacy and autonomy. This coincides with Section 1 of the CORU (2019) code of professional conduct and ethics for social workers.  Because Ken was involuntary admitted onto the psychiatric ward, the consultant psychiatrist may have implemented Part 4, Section 57,58 and 59, of the MHA, which highlights when treatment, without consent of the service user, can be given. Attaining consent from service users is a core requirement under Section 11 of CORU’s code. This breech corresponds with the first of the eight guiding principles associated with the CRPD, which states that; respect for the inherent dignity, individual autonomy, including the freedom to make one’s own choice, and independence of persons must be adhered to. In this instance, I feel that this guiding principle was not acknowledged.

The incident above also allowed me to investigate Ken’s right to will and preference, autonomy and self-determination. Article 12 of the CRPD states, that in all aspects of life, individuals have the right to make decisions for themselves and to have their decisions respected. A requirement relating to equal access to required supports available when exercising their legal capacity to make decisions is also stated. The right to autonomy is protected by the Irish Constitution, the European Convention on Human Rights (EUCHR) and the CRPD. The right to autonomy involves the capability for individuals to make decisions regarding their own life, based on their beliefs and values – a right to self-determination. Included in this is the right to refuse treatment (CRPD 2006). These right seems to have been overlooked in this incidence. 

People with mental health issues often have their rights limited. For example, under Section 3(1) of the MHA 01, it is possible to detain an individual against their wishes, therefore eliminating them their liberty due to their mental health problem. When a service user is being detained, this also has a knock on effect and compromises on their rights, under the UDHR (1948) to work, (Article 23) privacy, (Article 12) education (Article 26) or participation in society (Article 27) during their detainment. 

By adopting a human rights based approach to care, it is important to recognise every human being as a person, but also as a rights holder. The three main considerations include; respect, protect and fulfil (A vision for change: report of the expert group 2006). Mental health social workers play a huge role in guaranteeing that human rights are respected, protected and fulfilled. A simple way of guaranteeing this is by making sure that the voice of the service user is being heard. Adopting a human rights based approach to practice, involves implementing simple, yet effective changes in delivery of care. Developing clearer and simpler ways to communicate with service users can be one way. Another rights based approach involves advocating on behalf of the service user (CRPD 2006). The incident above could have easily been resolved by taking a human rights based approach. This would involve simply approaching Ken and asking him why was he pacing up and down the hall.

Under section 20 of CORU’s code of ethics, it states that you must raise concerns about safety and quality of care. Also associated to this is section 20.B which requires social workers to inform an appropriate person or authority if you are aware of systems or service structures that lead to unsafe practices which put the service users at risk. If I was adopting a human rights based approach, this section of the code would have been adhered to and questioned.

The United Nations Economic and Social Council (UNECSC 2015) third periodic report of Ireland highlighted concern relating to the severe lack of funding for mental health services, and the inadequacy in the legal framework for mental health, along with the lengthy adjournments in the implementation of AVFC 2006. Recommendations made by the council’s report included a revision of the MHA 01, coupled with a rapid implementation of AVFC through the allocation of sufficient resources.  However, in order for Irish law to become compliant with the CRPD, practice and the MHA and new capacity legislation must reflect the key human rights principles enshrined in the CRPD (Report of the steering group on the review of the MHA 2001).  

Under the CRPD, the writing of advanced directives by service users, where their will and preference in treatment is highlighted, forms an integral part of the Convention. However, under Irish law, there is presently no framework for the acknowledgement or application of advanced directives. A human rights based approach entails individuals to have other supports and treatments available, not just medications (CRPD 2006). Article 2 of the CRPD relates to the idea of ‘reasonable accommodation’. Under Irelands Equity Laws, reasonable accommodation is protected. This allows individuals with mental health problems to make amendments in their care so they can enjoy and apply their human rights on an equal basis with others. The human rights based approach starts by assuming that every individual has the right to autonomy and to make their own decisions.

By adhering to the CRPD and other associated Irish and international laws and acts, investigating this incident through a human rights lens has allowed me to develop an understanding of the subject area in more detail. By taking a simple, person centred approach to service user delivery in turn leads to adopting a more human rights based approach. By accumulating the various conventions, declarations or laws, and by adhering to CORU’s code of ethics for social workers, adopting a rights based approach will be to the forefront of my professional development.

Bibliography

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