“But what if nobody's going to sit down and have a real conversation with you?” Service user/survivor perspectives on human rights

Abstract

Purpose -The purpose of this paper is to discuss human rights assessment and monitoring in psychiatric institutions from the perspectives of those whose rights are at stake. It explores the extent to which mental health service user/psychiatric survivor priorities can be addressed with monitoring instruments such as the WHO QualityRights Tool Kit. Design/methodology/approach -The paper is based on the outcomes of a large-scale consultation exercise with people with personal experience of detention in psychiatric institutions across 15 European countries. The consultation took place via one focus group per country and extended to a total of 116 participants. The distinctive characteristic of this research is that it imparts an insider perspective: both the research design and the qualitative analysis of the focus group discussion transcripts were done by a social researcher who shared the identity of service user/survivor with the participants. Findings -The paper highlights human rights issues which are not readily visible and therefore less likely to be captured in institutional monitoring visits. Key issues include the lack of interaction and general humanity of staff, receipt of unhelpful treatment, widespread reliance on psychotropic drugs as the sole treatment and the overall impact of psychiatric experience on a person's biography.Research limitations/implications -Because of the way participants were recruited, the research findings do not offer a representative picture of the human rights situation in particular countries. They point clearly, however, to new directions for human rights research in the psychiatric context. Originality/value -This paper demonstrates the indispensability of experiential knowledge for not only securing and improving but also extending the understanding of human rights standards in psychiatry.

Relationships, autonomy and legal capacity: Mental capacity and support paradigms

“…There is only a very sparse literature on the experiences of people who are subject to guardianship and mental capacity laws; 71 this urgently needs remedying. If it is anything like the literature on subjective experiences of mental health laws, we should anticipate a diversity of views, but with a significant proportion feeling that coercive interventions were unjustified or unwelcome (for example, see: Katsakou and Priebe, 2006;Katsakou et al, 2010;Katsakou et al, 2012;Priebe et al, 2010;Russo and Rose, 2013). These studies also tell us that the quality of relationships play a key role in people's experiences of such interventions (Gilburt et al, 2008).…”

Experiences of in-patient mental health services: systematic review

“…Experiences of in-patient mental health services A total of 16 systematic reviews (Table A.1) which investigated in-patient experience were identified. In total, 72 studies were included in the review, a third of which were from the UK (n = 24) [19][20][21]25,27,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] (Supplementary Table 1 available at https://doi.org/10.1192/bjp.2019.22). Although studies using qualitative methods were most common (Table A.1), studies using patient experience questionnaires and patient record data were also included.…”

“…[25][26][27]31,32,35,36,43,44,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] Data were mostly collected just before, 28,29,45,[64][65][66][67][68][69][70][71][72][73] immediately after discharge 20,45,59,74,75 or from former in-patients. 22,23,34,[37][38][39]41,42,46,…”

Patient safety and staff competence in managing challenging behavior based on feedback from former psychiatric patients

“…Challenging behavior "threatens the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive, or result in exclusion" and is usually dangerous, frightening, or distressing to staff 4 and patients. 5 Using restrictive interventions to manage aggression can risk patient safety, in terms of psychological harm, injuries, or even restraint-related deaths. 6,7 Violence has been associated with delays in nursing tasks and increased medication errors.…”