Human rights and compassion in mental health care

Giant steps conference

Victoria’s healthcare quality and safety conference, Giant steps, was held on 21-22 November 2019 and hosted by Safer Care Victoria. Designed for all interested in finding a better, safer way to deliver healthcare, Giant steps featured 50 local and international speakers who presented within four key streams:

• quality improvement
• emerging health challenges
• leadership
• delivering high-quality care

A theme that ran through many of the presentations was the importance of ‘compassion in care’, by both individuals and systems. Compassion in care involves being sensitive and empathetic to health consumers’ individual situations, treating them with respect and humanity and working in partnership with them to aid their recovery. Compassion is an invaluable aspect of care as it provides consumers with emotional support.

Joshua’s story

The MHCC’s Principal Legal Officer, Isabel Anton, and Senior Adviser, Lived Experience and Education, Emma Bohmer, spoke at the Giant steps conference on the topic of 'Upholding human rights in responding to mental health presentations”. They told the story of Joshua as an example of lack of compassion in mental health care.

Joshua (name changed) is a young man who was admitted to a hospital’s emergency department. There he was mechanically restrained for eight hours before being discharged the next day. The MHCC investigated and found that Joshua was restrained for seven hours more than could be reasonably justified, in part because medical staff failed to conduct statutory reviews, recognize that he was settled, calm or sleeping, or escalate the matter to senior staff.

Joshua’s experience was highly distressing and has had a profound and enduring impact on him. It reflects the mental health services' staff’s desensitization and complacency about the gravity of using restraints.

The MHCC investigation found that there was a combination of factors that resulted in a profound systems failure: hospital staff should have removed the mechanical restraints from Joshua as soon as they were no longer necessary to prevent imminent and serious harm or administer treatment. Failure to do so breached Joshua’s right to receive the least restrictive treatment under the Mental Health Act 2014 (the Act) and to be protected from cruel, inhuman and degrading treatment and to be treated with humanity and with respect for the inherent dignity of the human person when deprived of liberty under the Charter of Human Rights and Responsibilities Act 2006 (the Charter).

As a result of the investigation, the hospital took significant actions to prevent a reoccurrence of Joshua’s experience, including redesigning processes, amending policies and training staff.

Restrictive interventions

The MHCC receives many complaints about the use of restrictive interventions (seclusion and restraint). Themes include:

• the significant impact on people of the use of restrictive interventions
• insufficient evidence that alternatives have been considered before using a restrictive intervention
• excessive use of force leading to allegations of assault, injuries and trauma
• lengthy periods of seclusion or restraint, raising concerns about the level of oversight
• non-compliance with provisions of the Act (including provisions about authorisation, review and documentation)
• lack of knowledge of Act and Charter responsibilities by staff
• confusion about whether emergency department or mental health staff are responsible for reviewing a person who is restrained in an emergency department
• lack of consideration of individual needs with regard to physical health, gender sensitivity and trauma history

In their presentation, Isabel and Emma emphasised that we must do better to protect human rights and prevent harm to people seeking mental health treatment. Some key points they made were that:

• the particular vulnerability of people detained in mental health services creates positive obligations on services to have systems that protect people from harm (including self-harm and assault from others) and uphold their human rights
• the MHCC is one of the key oversight and safeguard mechanisms established by the Act. It takes a rights-based approach and assesses complaints in accordance with the Act and its principles and the Charter
• the Charter requires public authorities to give ‘proper consideration’ to human rights when making decisions and powers under laws must be exercised consistently with Charter rights. Any limitations on Charter rights must be reasonable, justified, proportionate, logical and balanced