By Dr Judy Laing, Reader in Law (University of Bristol Law School).*
Recent research indicates that a large percentage 
of patients living with severe mental health problems do not feel actively involved in their treatment plans. In this blog, Dr. Judy Laing outlines how this runs contrary to basic human rights principles and how it’s time that patients’ rights and voices are put firmly at the centre of all decision-making about their care, treatment and admission to hospital.
To coincide with Mental Health Awareness week from 16-22 May 2016, the mental health charity, Rethink has published the results of a recent survey into anti-psychotic medication.
The survey was carried out at the end of April 2016 and received over 200 responses. Anti-psychotic medication is commonly prescribed for conditions such as bipolar disorder (manic depression) and schizophrenia. It can also be used to help to treat severe anxiety and depression. Anti-psychotic medication can be effective and help to control psychotic symptoms, but there are serious risks and side-effects associated with the treatment.
The Rethink survey found that 81% of the patients who responded had experienced some of these adverse side effects, including weight gain, facial twitches, insomnia and sexual problems. The results of the survey are worrying as they reveal that nearly half of the respondents (46%) said that they did not understand the different medication options available to them, including the side effects and a similar percentage (47%) said that they did not feel part of the decision making process when their medication was prescribed. The survey suggests that seriously ill and vulnerable patients are not routinely involved in these important decisions about their treatment. This runs contrary to basic human rights principles and the recommendations of a recent independent Mental Health Taskforce report ‘The Five Year Forward View for Mental Health’.
Reporting earlier this year, in February 2016, the report stresses that:
‘It is essential that people’s human rights to receive care in the least restrictive setting, to give or withhold consent, to use advance decisions and to maintain family life are respected and that inspections assess the extent to which these rights are supported. Individuals deprived of their liberty under the Mental Health Act should be offered information, advocacy and support.’ (p. 62)
Responding to the Rethink survey earlier this week, the Care Quality Commission (CQC), as the independent inspector and regulator of health and social care in England, highlighted similar findings in its annual report into the operation of the Mental Health Act 1983.
The Mental Health Act provides a legal framework for compulsory mental health treatment in England and Wales in cases where patients are severely ill. The Code of Practice, which accompanies the Act, requires health care professionals to actively involve patients in decisions about their care. But the CQC’s Mental Health Act Report in 2014/15 found that patients are not always involved or empowered in this way.
CQC inspectors visiting mental health units and hospitals found that many patients were not given information about their treatment or access to external support such as patient advocacy and care planning. As the CQC has pointed out, this can impact negatively on people’s recovery and could lead to longer hospital stays, poor discharge and readmission. Patients who are severely mentally ill are extremely vulnerable and it is vital for professionals caring for them to ensure that patients are fully supported, informed and empowered to make decisions about their care and treatment. The CQC has committed to take action to ensure that patients are effectively supported in this way. As the Mental Health Taskforce identified, health care professionals, providers and organisations involved with NHS health care provision need ‘a far more proactive and preventative approach to reduce the long term impact for people experiencing mental health problems and for their families’ (p. 4).
*Dr Judy Laing is a member of the CQC’s Mental Health Act Advisory Group, and advises the CQC on its approach to Mental Health Act monitoring. Judy’s funded research into the CQC has also helped the organisation to review its monitoring methods and to promote a progressive focus on protecting patient rights. Judy’s research highlighted that whilst inspectors are aware of relevant human rights standards and frameworks in their work, knowledge is patchy and inconsistent. Further action is therefore necessary to ensure that patient rights and voices are at the centre of all decision-making about their care and treatment.