Maintaining momentum: driving improvements in mental health care

The complaints we see: dignity and human rights

The NHS Constitution states that patients ‘have the right to be treated with dignity and respect, in accordance with [their] human rights’. Our casework shows that an individual’s human rights can be infringed as a result of poor care. For this reason, we consider the core human rights values of fairness, respect, equality, dignity and autonomy when applying the Ombudsman’s Principles for Good Administration

Patients who use mental health services should be treated with dignity at all times, particularly so in times of crisis, when an individual’s illness may compromise their ability to understand their own actions. It is vital to the trust we place in mental health services that they protect and respect our human rights when we cannot do so ourselves.

The Five Year Forward View for Mental Health reinforces how important it is for commissioners, providers and the CQC to protect human rights at times when a person’s capacity, autonomy, choice and control might be compromised. The strategy aims to ensure that a person’s rights to be treated in the least restricted setting, to give or withhold consent, to use advance decisions and to maintain family life, are respected.

Ms G

What happened

Ms G had a history of bipolar disorder and was detained under section 2 of the Mental Health Act 1983 after her family became concerned about her behaviour. On arrival at the ward, she was held in seclusion for 50 minutes before being reviewed by a doctor and joining the main ward. She was then returned to seclusion.

Staff later observed Ms G eating a sandwich that had menstrual blood on it and there was blood smeared on the walls. It was later reported she had inserted a plastic cup into her vagina. She was reviewed by a doctor, and the seclusion continued before she accepted antipsychotic medication.

What we found

Ms G was in acute mental health crisis. She had been assessed as being at an increased risk of harm to herself and others. The Trust recorded a clear and reasonable rationale for keeping her in seclusion. However, we found no evidence that Ms G was provided with sanitary products, which resulted in blood ending up on her food and

Ms G using a plastic cup to collect menstrual blood. We found the Trust’s Seclusion Policy states ‘patients will be treated with dignity and respect at all times’ and Ms G’s seclusion care plan states that her personal hygiene and toileting facilities should be considered, under the heading ‘dignity and respect’.

However, there was no mention that Ms G was menstruating and no care plan around this. Additionally, food was placed on the floor without consideration of Ms G’s circumstances.

We found that not providing Ms G with the sanitary products she needed compromised her dignity and hygiene. This was not in line with the Mental Health Act Code of Practice which states that seclusion arrangements should include an environment that takes account of a patient’s dignity and physical well-being.

We also found the Trust did not, on every occasion, fully explain what they were doing when administering medication by injection, which was not in keeping with established good practice or the Nursing and Midwifery Council’s Standards for medicines management. These failures caused Ms G distress and humiliation, which were compounded by the Trust’s failure to fully respond to her initial verbal complaint.

Our recommendations

We recommended the Trust write to Ms G to acknowledge and apologise specifically for the failings we identified. Additionally, we recommended the Trust prepare an action plan to describe what they would do to prevent a recurrence of these failings, and send this to the CQC.

The action plan produced by the Trust showed it had:

  • Raised awareness with staff of the need to maintain personal hygiene in seclusion, with discussions in team meetings.
  • Discussed privacy and dignity issues at the Trust’s learning lessons group and seclusion steering group.
  • Highlighted the need for explanation of administering medication by injection within the learning lessons group and seclusion steering group for all clinical teams.

Human rights in mental health care

All public bodies and their employees have, under the Human Rights Act 1998, a duty to protect, respect and fulfil people’s human rights. This includes NHS services and staff, as well as services provided by third parties on behalf of the NHS. The NHS Constitution clearly states: ‘You have the right to be treated with dignity and respect, in accordance with your human rights.’

There are many aspects of mental health care where human rights are particularly relevant, such as detention under the Mental Health Act 1983. The British Institute of Human Rights has produced a series of practitioner toolkits that put human rights into the context of mental health care, showing examples of how taking a human rights based approach leads to better services and care.