{"id":37285,"date":"2016-11-17T10:09:51","date_gmt":"2016-11-17T09:09:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37285"},"modified":"2016-11-17T10:11:48","modified_gmt":"2016-11-17T09:11:48","slug":"indermeet-sawhney-incapacitated-patients-and-rights-to-liberty","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/17\/indermeet-sawhney-incapacitated-patients-and-rights-to-liberty\/","title":{"rendered":"Indermeet Sawhney: Incapacitated patients and rights to liberty"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Article 5 (4) of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Convention_on_Human_Rights\">European Convention on Human Rights<\/a> (ECHR) underpins everyone\u2019s right to liberty<\/span><span style=\"font-weight: 400\">. This fundamental principle dictates the rights of patients under the statute of the UK <a href=\"http:\/\/www.mind.org.uk\/information-support\/legal-rights\/mental-health-act-1983\/?gclid=COjP-Kb02c4CFYUK0wodgjEGZQ#.V71_pPkrLct\">Mental Health Act<\/a> and the <a href=\"https:\/\/www.mencap.org.uk\/advice-and-support\/mental-capacity-act?gclid=CNudorX02c4CFROeGwodWjAHSA\">Mental Capacity Act Deprivation of Liberty<\/a><\/span><span style=\"font-weight: 400\">. There are safeguards in both pieces of \u00a0legislation to ensure patients are able to exercise this fundamental right and challenge their detention. The law is universal and makes no distinction for any patient irrespective of their capacity to appeal. However, if incapacitated patients have no access to the safeguards in place they are in reality meaningless\u00a0and tokenistic.<\/span><!--more--><\/p>\n<p><span style=\"font-weight: 400\">The <a href=\"http:\/\/www.echr.coe.int\/Pages\/home.aspx?p=home\">European Court of Human Right<\/a> judgement in the case of\u00a0 <a href=\"http:\/\/thesmallplaces.blogspot.co.uk\/2013\/10\/mh-v-uk-implications-for-deprivation-of.html\">MH v the United Kingdom<\/a>,\u00a0 held that &#8220;special safeguards&#8221; need to be in place in order to protect the rights of persons who lack capacity to challenge the lawfulness of their detention under the Mental Health Act<\/span><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"text-decoration: underline\"><strong>About &#8220;MH&#8221;<\/strong><\/span><\/p>\n<p><span style=\"font-weight: 400\"><a href=\"http:\/\/www.doughtystreet.co.uk\/news\/article\/judgment-in-mh-v-united-kingdom\">MH<\/a> was a woman with Down&#8217;s Syndrome and severe learning disabilities who lived with her mother and was admitted to hospital under Section 2 of the Mental Health Act. The consultant psychiatrist blocked her mother\u2019s application for MH\u2019s discharge and MH was unable to challenge her own discharge. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The same message was echoed in the judgment in the case of <a href=\"http:\/\/www.39essex.com\/cop_cases\/aj-v-a-local-authority\/\">AJ for a local authority<\/a>\u00a0legislation<\/span><span style=\"font-weight: 400\">. <\/span><span style=\"font-weight: 400\">The court flagged up the obligations of the local authorities in facilitating and ensuring patients deprived of their liberty have access to the <a href=\"https:\/\/www.gov.uk\/courts-tribunals\/court-of-protection\">Court of Protection<\/a> to secure their rights of appeal under Article 5(4). <\/span><span style=\"font-weight: 400\">AJ, an 88 year old woman with dementia, had moved to live with her niece and her husband (&#8220;Mr and Mrs C&#8221;) to whom she had given lasting powers of attorney in respect of both welfare and financial affairs. <\/span><\/p>\n<p><span style=\"font-weight: 400\">She objected to a decision to move her to a care home on a long-term basis after a respite placement when Mr and Mrs C were on holiday. The council appointed Mr C as AJ\u2019s Relevant Person&#8217;s Representative. These are appointed for the duration of a deprivation of liberty safeguard when there is no one in a\u00a0person\u2019s life who is willing or able to act as his or her representative. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet despite AJ\u2019s known opposition to the care home placement, no legal challenge was made to the deprivation of liberty authorisation until more than six months after she was admitted into residential care<\/span><span style=\"font-weight: 400\">.\u00a0<\/span><span style=\"font-weight: 400\">The judge held that as Mr C supported her being placed in the care home long term he should not have been appointed relevant person&#8217;s representative, and the steps taken by the local authority to ensure that AJ\u2019s challenge to the deprivation of her liberty was brought before the court were inadequate.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Intuitively, one would think that those without capacity are the most vulnerable and hence need greater protection of these rights.<\/span> <span style=\"font-weight: 400\">It is ironic how this very group of defenceless patients are unable to exercise those very rights. These recent case laws have underscored the same message of enabling and protecting the fundamental rights of liberty for incapacitated patients. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The decision is significant and ensures equality of access of safeguards for patients who are deemed to be incapacitated. This impacts patients in psychiatric hospitals, general hospitals, and the community, who are under the framework of Mental Health Act or Deprivation of Liberty Safeguards. <\/span><\/p>\n<p><span style=\"font-weight: 400\">As professionals working with the vulnerable group we need to ensure that detention is not a default position for them. <\/span><\/p>\n<p><span style=\"font-weight: 400\">For patients detained under the Mental Health Act <\/span><span style=\"font-weight: 400\">the treating consultant psychiatrist needs to assess the capacity of patients to apply to the tribunal at the outset of admission and on renewal of their section. <\/span><\/p>\n<p><span style=\"font-weight: 400\">As a safeguard for this group of \u00a0incapacitated patients, referrals need to be made to the tribunals as a routine without exceptions by the hospital managers<\/span><span style=\"font-weight: 400\">. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Implementing the ruling in practice has ramifications in terms of resources and costs.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">For the Mental Health Act it implies a huge surge in the number of tribunal hearings and setting up tribunal panels for the already stretched tribunal services and the treating team having to devote time to prepare reports and attend the hearings will be challenge. <\/span><\/p>\n<p><span style=\"font-weight: 400\">For the <a href=\"http:\/\/www.scie.org.uk\/publications\/ataglance\/ataglance43.asp\">DOLS <\/a>it implies local authorities will have to rely on paid advocacy services to undertake take the role of relevant persons representative as opposed to family members<\/span><span style=\"font-weight: 400\">. <\/span><\/p>\n<p><span style=\"font-weight: 400\">However, resource implications <\/span><span style=\"font-weight: 400\">cannot and should not be a reason to deny the most marginalised in society their basic human rights. It\u2019s no good being just aware of the gap, its high time it is bridged too.<\/span><\/p>\n<p><strong>Indermeet Sawhney<\/strong> is a consultant psychiatrist at Hertfordshire Partnership University NHS Foundation Trust.<\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Article 5 (4) of the European Convention on Human Rights (ECHR) underpins everyone\u2019s right to liberty. This fundamental principle dictates the rights of patients under the statute of the UK [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/17\/indermeet-sawhney-incapacitated-patients-and-rights-to-liberty\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-37285","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Indermeet Sawhney: Incapacitated patients and rights to liberty - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/11\/17\/indermeet-sawhney-incapacitated-patients-and-rights-to-liberty\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Indermeet Sawhney: Incapacitated patients and rights to liberty - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Article 5 (4) of the European Convention on Human Rights (ECHR) underpins everyone\u2019s right to liberty. 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