MENTAL HEALTH CARE
Rights and Responsibilities
The Equality and Human Rights Commission’s report ‘Preventing Deaths in Detention of Adults with Mental Health Conditions’ has shone the spotlight on serious failings in mental health care provision in England and Wales. Tanita Cross reports.
Between 2010 and 2013, 367 adults with mental health conditions died of non-natural causes while detained in psychiatric wards and police cells in England and Wales. This figure prompted a major enquiry by the Equality and Human Rights Commission into how the human rights of detainees with poor mental health are protected across the health, prison and police settings.
Through consultation with organisations including the Care Quality Commission (CQC), Healthcare Inspectorate Wales (HIW), Her Majesty’s Inspectorate of Constabulary (HMIC) and many others, the EHRC began to build a picture of the way people with mental health conditions had been treated while in the state’s custody. Official information was complemented with evidence gathered from the family members of those who had died.
Repeated basic errors, a failure to learn lessons and a lack of rigorous systems and procedures were the three primary failings that the Commission came across during its investigation. Professor Swaran Singh, Lead Commissioner on the inquiry said: “The Commission, as Great Britain’s National Human Rights Institution carried out this Inquiry, in consultation with other expert bodies, to examine what lessons can be learned and how to prevent further unnecessary and avoidable harm and heartbreak.”
Among the basic mistakes that were uncovered was the failure to properly monitor patients and prisoners at serious risk of suicide, even when their records recommended constant
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or frequent observation. A high number of deaths shortly after leaving detention were also reported. This raised serious questions about whether the appropriate follow-up mental support was put in place.
Among the basic mistakes that were uncovered was the failure to properly monitor patients and prisoners at serious risk of suicide.
Poor communication between staff was also highlighted as it led to failures to update and share patients’ risk assessments following self-harm or suicide attempts and crucial information being missed. Gathering information about patients and prisoners was also found to be flawed, since the families of detainees were not properly involved.
This made it difficult for relatives to share important information which they feel might have prevented deaths, such as previous treatment plans or trigger points for self-harm like anniversaries of bereavement or relationship difficulties. Detainees were refused contact with their family members at a time when they were particularly vulnerable, or were unable to see them because they were held a long distance away from the family home.
Mark Hammond, CEO of the Equality and Human Rights Commission
www.tomorrowscare.co.uk
commented: “This Inquiry reveals serious cracks in our systems of care for those with serious mental health conditions. We need urgent action and a fundamental culture shift to tackle the unacceptable and inadequate support for vulnerable detainees.”
As a result of its inquiry, the Commission has created a Human Rights Framework, aimed at policy makers and frontline staff across all health, prison and police settings, which includes 12 practical steps to help protect lives. The Commission’s wider recommendations are addressed at government, regulators and inspectorates and the leaders and managers of individual institutions. Its advice covers four key areas:
• Learning lessons and creating rigorous systems and processes
• A stronger focus on meeting basic responsibilities to keep detainees safe
• Greater transparency and robust investigations
• The EHRC Human Rights Framework should be adopted and used as a practical tool in all three settings
Mark Hammond emphasised: “The improvements we recommend aren't necessarily complicated or costly: openness and transparency and learning from mistakes are just about getting the basics right. In particular, by listening and responding to individuals and their families, organisations can improve the care and protection they provide.”
www.equalityhumanrights.com
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