Recommendation 4 (human rights)
In our Out of sight report we found that people’s rights, including their human rights, were at risk of being breached. We highlighted the need for staff to understand and embed the principles of the Human Rights Act so that where restrictive interventions are being used, staff reflect and understand their impact.
This included people’s rights under the Equality Act 2010 to have reasonable adjustments in place to meet their needs. We therefore made recommendations to ensure that people’s rights were met in inpatient units and in adult social care services.
If recommendation 4 was fully implemented, people:
- would have all their rights met, including their human rights. This is because:
- human rights would be embedded within the service provided to the person
- staff would understand the Human Rights Act and the Equality Act
- the appropriate resources would be in place to support people to meet their needs
- in inpatient units would be given accessible information to help them understand their rights under the Mental Health Act and what to do if they do not feel these are being met
- with a learning disability and autistic people would have had reasonable adjustments put in place to meet their needs, such as individual sensory or communication needs.
Has recommendation 4 been achieved?
We consider that recommendation 4 has not been achieved
People’s human rights continue to be at risk. They are not benefiting from reasonable adjustments under the Equality Act or from an understanding of human rights.
Action needed:
- Leaders within organisations should promote knowledge and understanding of human rights and rights under the Equality Act.
- Individual reasonable adjustments should always be in place for autistic people and people with a learning disability.
What we are seeing and hearing
From the stories that we have shared in this report and others that are frequently reported on, we know that people are not always having their rights acknowledged and respected. People are often not seen as individuals, of equal value and worth, whose views are listened to and respected. Recognising the humanity of each person and making sure this underpins all aspects of care is fundamental to supporting all people.
The information below relates specifically to autistic people and people with a learning disability.
Findings from IC(E)TRs
Forty-six of the 77 IC(E)TRs (60%) included evidence related to poor care and potential human rights breaches. These included restrictions on access to personal possessions, fresh air, activities, telephones, and visitors for which there was no justifiable reason or clear rationale. We found that steps taken to manage people's risks did not consider the impact on their dignity and were frequently unnecessarily harsh or overly restrictive. We also found that people's needs in relation to physical health were not being considered or accommodated, such as people being denied access to dentists or opticians.
Equality Act
Understanding of the Equality Act and ensuring that individual reasonable adjustments are made for people with a learning disability and autistic people is essential for ensuring that true person-centred care is delivered. Where this is not in place, restrictive interventions are more likely to occur as staff teams are less likely to understand people’s needs such as communication needs or sensory sensitivities. From 2016 all health and social care services should be complying with the Accessible Information Standard which set out a specific, standard approach to ensuring disabled people’s needs are met.
Claire’s experience of person-centred care
I am autistic and have significant physical and mental illnesses.
During one of my mental health admissions a nurse worked with me to look at ways I could communicate with the staff in times of distress, and we came up with a cue cards system. These were cards I designed myself that I could either give to staff if things were in the process of escalation. Or else, if I was going into shutdown, I could leave a card in front of where I was curled up (likely on the floor). Each card had a corresponding list of things that might help me settle and things that could put me in even more overload. All staff had access to these lists.
These were co-developed with the ward team, and they really helped me express myself safely and helped the staff respond appropriately. There were many occasions, which may have led to restrictive measures, that were diffused before getting to that point.
However, I tried implementing them with staff on wards in subsequent admissions and they either didn’t want to engage, or not all staff knew about the system. There were times I would be in shutdown and staff would be shouting at me or even trying to physically manhandle me, which inflicted further trauma upon me. I felt particularly distressed, as almost all those incidents could have been avoided had the staff engaged with the cue cards system I offered them early in the admission.
Accessible information
In our Out of sight report we recommended that people in inpatient units are given accessible information about their rights. However, the Mental Health Act reviewers we spoke with found there had been little progress on this. Mental Health Act reviewers check whether people detained under the Mental Health Act have been given information about their rights. They found that this is more of a tick-box exercise without consideration of whether the person had understood what they are being told, if they have been able to retain that information, or what measures could have been taken to improve this. The British Institute of Human Rights has provided guidance to support inpatient units in doing this.
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