19 April 2018
This is the testimony of a forensic patient;
how he felt and how he feels about his rights at different stages
in his hospital care and treatment.
My understanding is that when someone is admitted to hospital
they have the right to have their property looked after by the
local authority for a given period of time. In my case this right
was not respected. There was a mistake, the housing authority
thought I'd abandoned it, so my flat was emptied of all contents.
This was not the fault of the hospital, the mistake was elsewhere,
but I was completely gutted.
In my admission to hospital itself, I remember someone told me
about my right to appeal my detention, but I don't remember
receiving any more information about my rights at that time. I do
tend to ask a lot of questions though, and I probably gathered most
of my information that way.
I always appreciate it when the manager of a ward I have just
arrived in makes a point of introducing himself or herself to me,
and this did happen, more often than not. I think it is good when
they do that because then they come across as more approachable and
the patient feels that bit more welcome. But I actually think they
should go a bit further: I think they should make it explicit, when
introducing themselves, that the patient can come to them with
anything they are unhappy about, or anything they think is wrong
with their care. I think the onus is on them to make themselves as
approachable as possible. Obviously patients should always feel
they can speak to the nurses about any issues they have, but with
the more senior nurses it's a bit different. They are sometimes
able to help with issues that others can't (such as nursing
conduct) but I think are potentially seen by some to be less
approachable, due to their seniority and the fact that their job
involves spending a lot of time in offices, on computers.
On the ward
Rights in Mind talks about restrictions on the ward. There is a
level of strictness in forensic units that is not typical in acute
wards. We are told it is for the safety of all concerned and to a
large extent I accept this to be true. But there has always been a
tension between this concern and allowing patients the freedom to
live as happily and unhindered as possible. I understand the need
for keys and locked doors but when I've moved from hemmed in
conditions to a more relaxed conditions, I've noticed an increase
in my confidence levels.
Rights in Mind also talks about a patient's rights to activities
for therapy and recreation on the ward. In my experience, forensic
units have usually had sufficient numbers of staff to provide
therapeutic activities, access to education, and to facilitate
Pass. These are essential to alleviate boredom, to give patients a
sense of purpose and achievement, and sometimes to rehabilitate or
teach us skills. Through my work with the Patients' Council I have
learned that in other parts of the hospital, such as acute wards,
resources are much more limited.
The most expensive resource is staff and they are often the most
necessary; for getting out for a walk, but also just to talk to.
For people who often aren't feeling their best, this is help that
is sorely missed on a busy, under-staffed ward.
One positive thing has been the extent to which senior nurses
have generally been very happy to listen and talk to me about the
various issues I've had with life on the ward - about my own care,
or how the ward is run. Sometimes the ward manager will have a word
with a member of staff, or he'll take on board a point and a
certain practice will stop, start, or change, and life for patients
will improve in some small way. Even if they don't agree with me,
he or she will usually explain why, which I appreciate.
There have been great opportunities to be involved more formally
in decision making. In one hospital, a group of patients met twice
weekly to work with a small team of staff to make patients' voices
heard. The meetings were chaired by an elected patient, and
sometimes individual patients would attend meetings that were
otherwise solely comprised of staff. This group was instrumental in
advancing patients' rights in the hospital, and demonstrated that
staff were actively trying to work with patients to improve their
lives as far as possible in that environment.
In my current hospital, which is not just for forensic patients,
I am part of a group advocacy project, called The Patients Council,
consisting of volunteers who are, or were, patients, and two paid
members of staff who are completely independent of the NHS. It
helps present patients' views, and fight for their rights at
meetings we attend with professionals in the hospital, or with
organisations and authorities in the community.
It is one of our rights, in law, to have access to independent
advocacy. I believe all hospitals now provide an independent
advocacy service, but many, including the one I may be moving to
next, do not provide group advocacy. I think that is bad, because
the advocacy work we do here is so beneficial to patients. I find
this work very fulfilling - I believe I am quite good at it and I
know others value it.
A good example of our group advocacy's work on human rights is
our campaign to raise awareness of the fact that the United Nations
Committee on the Rights of People with Disabilities (UNCRPD)
recently stated that it is actually against our human rights for
compulsion and force, and even detention, to be used against
patients, just because we have a disability (mental illness). It is
a very thorny issue, one I struggle with myself. But there's a
small, and growing, body of evidence and precedents to show that
even people with intractable mental health issues can be
successfully treated by alternative methods which don't involve the
use of force or, sometimes, even medication.
As well as the group advocacy work that I've discussed, there
are of course also advocacy services that offer help to patients on
a one-to-one basis. Lots of patients take advantage of their help
to deal with their doctor, clinical team, tribunals or whoever else
- they are all about helping individual patients have their voices
heard. I found them helpful in a variety of situations, such as
advising me of the best way to communicate effectively with those
in positions of power outwith the hospital. The advocate worker I
dealt with was very experienced, and able to give good guidance.
There are advocacy services in the community as well, which I think
is a good thing, as it's not just people in hospital who need
Whatever the context, I believe that if people's voices are
better heard, then they are better able to fight for their rights
and, sometimes, the rights of others.