Rights of Mentally Ill Patient

Rights of the mentally ill patient:

• Right to the least restrictive treatment alternative,
• Right to informed consent,
• Right to refuse treatment,
• Right to confidentiality,
• Right to keep personal items.

                                                                          (Source: Universal Bill of Rights for Mental Health Patients)

Right to the Least Restrictive Treatment Alternative

The nurse must make an effort to care patients in a way that limits freedom the least. Patients in mental health facilities are not allowed to be restrained or segregated until an emergency arises. Never are restraints or isolation used as a form of punishment or for staff convenience.

An individual whose conduct is out of control and who constitutes an inherent risk to the physical safety and psychological well-being of the individual and staff or others is placed in isolation or restraint.

Types of Restraints:

• Chemical Restraints :Use of major tranquilizers, sedatives and hypnotics to calm the affected individual
• Mechanical Restraints:
  • Use of set of leather straps to restrain the extremities of the individual
    • 2-point minimum use.
    • 5-point maximum use.
  • Individual is always in seclusion if in restraints.
• 3. Physical Restraints
  • Seclusion (solitary confinement in a locked room)
  • Holding (used with smaller children)

Note: Requires 1/1 supervision in all types of restrains

Restraints and Seclusion Guidelines

• Restraints or seclusion can be initiated without a physician's order in an emergency.
• Physician must be notified for an order within 1 hour of initiation.
• Renewal of restraint or seclusion orders.
• Every 4 hours for adults.
• Every 2 hours for children 9 years and older.
• Every 1 hour for children younger than age 9.
• In-person evaluation of individual in restraints or seclusion by the physician.
• Within 4 hours of initiating restraints or seclusion for an adult.
• Within 2 hours of initiating restraints or seclusion for a child.
• In-person re-evaluation of individual in restraints or seclusion by the physician.
• Every 8 hours for an adult.
• Every 4 hours for a child.
• The nurse must assess and document circulation, respiration, nutrition, hydration, and elimination every 15 minutes

Right to Informed Consent

• The client's consent to get treatment is known as informed consent.
• The doctor is responsible for obtaining informed consent under the law.
• In order to guarantee that informed consent was gained, the nurse works as the client's advocate.

Major Elements of Informed Consent

• Knowledge.
• Competency.
• Free will.

Note: Treatment may be performed without obtaining informed consent under these conditions:

• The client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm
• Refusal endangers the life or health of another
• An emergency situation
• Client is a minor
• Therapeutic privilege (full disclosure would complicate treatment, cause severe psychological harm, or be so upsetting as to render a rational decision impossible)

Right to Refuse Treatment

• The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his or her action

Right to Confidentiality

• Pt's privacy is protected.
• Protection of clients records and communications as per state statute.

Right to Keep Personal Items

• People in a hospital or other treatment facility retain the right to keep their personal possessions.
• Items must be protected and returned upon release from the facility.
• Exceptions include:
  • The belonging poses a serious threat to self or others,
  • Items that may be dangerous would be held in a secure place during hospitalization,
  • Personal items must be returned to the client upon release from the facility.