Mental Health Handbook : Your Rights & Complaints

Your rights as a user of services

As a user of mental health service you have a right to expect that the Health Service and the Local Authority Social Services provide care and treatment which meets your needs. You also have a right to expect that care and treatment is provided in a way which takes account of your views, and that you are treated with consideration and respect. You have a right to information about treatment, its effects and side effects. You have a right to equal access to effective services whatever your culture, ethnic or national origin.

Health care

If you have a mental illness or other mental disorder, you have a right to medical treatment from a GP and where necessary from the specialist psychiatric services. You can ask your GP to refer you to a psychiatrist; you may also ask your GP or psychiatrist to refer you for a second opinion to another psychiatrist (there is no legal right to this). Your GP or psychiatrist is responsible for arranging treatment which is needed. In Hillingdon this is usually provided locally, but if you have unusual problems or special treatment requirements, your doctor may arrange for you to be seen at an appropriate hospital or clinic outside the borough.

Hospital treatment as an in-patient may be provided if your psychiatrist decides this is necessary. The Government has directed that “if a patient’s minimum needs for treatment in the community cannot be met, in-patient treatment should be offered or continued

Community care

Health and Social Services have a legal duty to assess the community care needs of people with mental health problems. The services you are provided with will depend on the assessment made of your need, and may be provided directly by Social Services, by the Health Service, or by voluntary or private organisations. Health and Social Services should work in a co-ordinated way to provide the care that is needed.

Aftercare

Under Section 117 of the Mental Health Act, people who are being discharged from a treatment order (Section 3) or a hospital order made by the Courts (Section 37) have a legal right to aftercare. Health and Social Services in Hillingdon have agreed procedures to make sure that the need for care is properly assessed and planned, before a person leaves hospital, and is then regularly reviewed with the person’s involvement and agreement.

The Care Programme Approach

Under the Care Programme Approach, the Primary Care Trust is directed to ensure that people referred to specialist psychiatric services should receive an assessment of their needs and that professionals should work together with patients and carers in agreeing a care plan which is then reviewed regularly. There is a local policy in Hillingdon.

Access to records

If you are in contact with Social Services you have a right to see written records about you. If you disagree with anything that has been recorded you may ask for it to be changed or deleted. If this is not agreed, you have the right to require that a record is made of your objection and your point of view.

Since November 1991, you also have a right to see your medical records and to correct any mistakes. With both medical and Social Services records, you may not be allowed to see records if it is considered that this may lead to harm to you or others.

National Service Framework for Mental Health

The National Service Framework was introduced by the Government to set standards for all mental health services. These standards set out what health and social services should be available to everyone. There are seven standards which include:

• Mental health promotion
• Primary care and access to services
• Effective services for people with severe mental illness
• Caring about carers
• The action necessary to reduce the national suicide rate

Local health and social services are required to address the gaps in the existing services to bring them into line with the required standards. This could mean services such as 24 hour nursed care and local provision of secure accommodation.

There are also targets to be met, for example reducing the suicide rate by one fifth by 2010.

Your right to have your voice heard

Users and ex-users of services have first-hand experience and an understanding of the whole mental health system that policy makers and service planners are keen to hear. If you would like to contribute your ideas on the way in which Mental Health Services are delivered in Hillingdon, please contact the Joint Commissioning Manager for Mental Health at:

Hillingdon Primary Care Trust, Kirk House, High Street, Yiewsley UB7 7HJ

There are a variety of forums which exist where users’ views are welcomed and taken into account: your views can make a real difference.

Your rights as a patient

If you are an ‘informal’ hospital patient, you are in hospital on a voluntary basis and you are free to leave or refuse treatment whenever you wish. If you are detained under a Section of the Mental Health Act however, you may be legally held in hospital against your will, but you still have certain rights. Your main rights are listed below.

The right to refuse treatment

You may refuse treatment if you are detained under Sections 4,5,135, or 136 of the Mental Health Act.

If you are on a Section 3, you have the right to refuse drug treatment after three months; you cannot then be compelled to have further treatment unless an outside psychiatrist appointed by the Mental Health Act Commission interviews you and agrees that your treatment should continue.

Under any Section you may refuse electro-convulsive therapy (ECT) unless any outside psychiatrist appointed by the Mental Health Act Commission interviews you and agrees that it is necessary.

In an emergency you may be given treatment against your will where immediate action is necessary to save life or to prevent serious and immediate danger to you or others. Treatment may then be given in order to bring the emergency to an end. This applies to informal patients and detained patients.

The right to appeal against detention

If you wish to leave hospital, you should start by discussing this with your psychiatrist, who can discharge you, and with your Nearest Relative who is entitled to ask for your discharge. However, you also have the right to appeal yourself against detention in hospital to the Mental Health Tribunal

The Tribunal consists of a lawyer (who chairs the Tribunal), a specially appointed psychiatrist not connected with the local service, and a lay person. The Tribunal will hear your case and have the power to order your discharge. You have the right to be present at the hearing and to be legally represented, and also to ask for a report from an independent doctor. You may be able to get Legal Aid to cover the cost of legal representation and of any independent reports.

Your rights to appeal are as follows:

Sections 4, 5, 135, 136: there is no right of appeal

Section 2: you may appeal within 14 days of your detention

Sections 3 and 7: you may appeal once in the period up to six months and once between 6 and 12 months after the section comes into force, and then once each year after that.

If you are detained under Part lll of the Mental Health Act (that is by a court order or transfer from prison), your initial rights of appeal are likely to be through the court system. If you need information about this, ask hospital staff and you may need to consult a solicitor.

If you do not apply to the Tribunal yourself, your case will be automatically referred to the Tribunal at the end of six months if you are on a Section 3, and then every three years. If you are on a Section 37 (a hospital order made by the Courts) your case will be automatically referred after three years.

Any detained patient may also apply to the hospital managers for their case to be reviewed. The hospital managers also have the power to discharge you.

how to appeal:

You should tell the hospital staff that you wish to appeal either to the Tribunal or to the hospital managers. They have a legal duty to arrange for you to be given information and help to appeal.

The right to information

When you are admitted to hospital under a Section of the Mental Health Act, the hospital staff have a duty to inform you which Section you are under, and the effect of the Section. They must also inform you of your rights to appeal to a Mental Health Review Tribunal and to the hospital managers. This information must be given to you in writing, and explained to you, as soon as possible after your detention.

The hospital also has a duty to give the same information about your detention to your nearest relative, and also give them notice of your discharge from hospital. If you do not wish your nearest relative to be informed, you have the right to request that this information is not given.

Advocacy

Mental Health Advocacy Service, HAVS, Kirk House, High Street, Yiewsley UB7 7HJ. Phone: 01895 442 738. Email: mentalhealthadvocacy@havs.org.uk

The Mental Health Advocacy service offers independent support and/or representation at ward rounds, CPAs etc to people using mental health services in Hillingdon. This is both during in-patient admission and subsequent discharge into the community.

They have three locality-based advocates available to clients at the Riverside Centre, Hillingdon Hospital and the three Community Mental Health Centres.

Advocacy services are also available for the Asian Languages community and for older people with mental health problems at Woodland Centre, Hillingdon Hospital.

User groups are facilitated at all three Community Mental Health Resource Centres by the User Empowerment Project Officer at HAVS and details of the operation of the Patients Council at the Riverside Centre which seeks to improve services offered to in-patients can be accessed via the service.

Your rights as a carer

Carers have a right to expect that mental health professionals will listen to them and consider their views, and involve them in care planning where carers are making a significant contribution to the support of the person concerned. Whilst this may conflict with the wishes of the person, carers should at least expect to be able to put forward their views, and to receive advice and support in their own right. You can contact the NSF Support Worker on 01895 258788..

Your rights as nearest relative

Under the Mental Health Act the Nearest Relative of a person with a mental disorder has various legal rights.

The Nearest Relative cannot be chosen by the person concerned, in the same way as a next of kin. The definition is set out in section 26 of the Mental Health Act. The Nearest Relative is the person who comes nearest the top of the following list, with precedence given to the older if there is more than one relative of the same description:

• husband or wife (except where permanently separated or where one partner has deserted the other)
• partner of the opposite sex where cohabiting for not less than six months
• son or daughter
• father or mother
• brother or sister
• grandparent
• grandchild
• uncle or aunt
• nephew or niece
• anyone who has lived together with the person for not less than five years, providing there is no other relative

There are a number of exceptions including where a relative on the list lives with or cares for the person they take precedence. Your main rights as nearest relative are listed below:

You may ask for an approved social worker to arrange for a formal Mental Health Assessment, and to be informed in writing of the reasons if no application for hospital admission is then made (Section 13(4) of the Mental Health Act).

You may apply yourself for your relative to be admitted to hospital. This must be based on the recommendations of two doctors. The preferred applicant would normally be the approved social worker.

You have the right to be consulted where your relative is being assessed under the Mental Health Act. For a treatment order (Section 3) or Guardianship you may also prevent an application being made.

You may order the discharge of your relative from hospital under Sections 2 or 3, giving 72 hours notice in writing. The psychiatrist may overrule this if he/she considers that the person is a danger to themselves or others. If the psychiatrist does this, you can appeal to a Mental Health Tribunal. You also have the right to discharge your relative from Guardianship.

You have the right to information from an approved social worker about your role as nearest relative and your right to discharge your relative

You have the right to information from the hospital about the effect of detention under the Mental Health Act, and rights of appeal. You also have the right to be informed by the hospital about your relative being discharged from hospital, with seven days notice if practicable. The patient may, however, ask the hospital not to give you this information.

In exercising your rights as Nearest Relative, it is assumed that you are yourself mentally competent, and that you are acting in a reasonable way which takes account of the welfare of the patient and the interests of the public. If this is in dispute, it is possible for your rights as nearest relative to be assigned to someone else by the County Court. If you do not wish to act as nearest relative, you may agree with another suitable person for them to take on the role (you can contact the Community Mental Health Team for advice about this)

Complaints

In general, the professionals who provide the various services referred to in this handbook try hard to do a good job, and to listen to your point of view. However, things can go wrong, in which case your starting-point should be to discuss the issue with the person concerned. If this does not resolve the problem and you are not satisfied with the outcome, you should consider making a complaint. It may help to talk the problem over with an independent person first, for example through contacting the Community Health Council, Hillingdon Mind or NSF who may be able to help and support you in making a complaint, and refer you to an advocacy service.

Who should you complain to?

This depends on who is responsible for the service you are complaining about and whether they have a ‘Complaints Procedure’. Social Services, The Hillingdon Hospital Trust and Hillingdon Mind have complaints procedures:

Social Services

Stage 1
Talk to the staff concerned and try to sort the problem out.

Stage 2
If you feel you can’t talk to the staff concerned or have tried and are still not happy, ask to talk to their manager who will look into the problem for you.

Stage 3
If that doesn’t help, telephone or write to the Complaints Unit at the Civic Centre who will investigate your complaint within 15 working days.

Complaints Manager, Civic Centre, Uxbridge UB8 1UW. Phone: 01895 277 800

Stage 4
If you are still dissatisfied after the investigation, you can have your complaint heard by a panel of independent people.

Your Local Councillor

You are entitled to contact your local councillor about any Council service. You can find out who your local councillor is by contacting your library, the Civic Centre, or any Council office.

The Health Service

First discuss the service you are dissatisfied about with the person who provides it, making it clear that you are dissatisfied. He/she may be able to sort the problems out. If you are still not satisfied and the complaint is of a clinical nature (that is about your treatment), ask to make an appointment to see the consultant.

If, however, it is an issue relating to a specific professional, ask to see the senior clinical manager.

If you still feel unhappy after speaking to either the consultant or senior clinical manager, you can write to:

Chief Executive, Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN

S/he will investigate and respond to you directly.

It may also be beneficial to contact the Community Health Council who will assist and advise you about local services, clinical complaints procedure and the Health Service Ombudsman.

Hillingdon Community Health Council, 65 Belmont Road, Uxbridge UB8 1QT. Phone: 01895 257 858

GPs

If you have a complaint about a service from your GP you should first try to resolve it with the practice. If you are not happy with the result of this you can contact Customer Services Manager at the address below. They will be able to advise you on other options that may be available.

Customer Services Manager, Hillingdon Primary Care Trust, Kirk House, High Street, Yiewsley UB7 7HJ. Phone: 01895 452 000

You also have the right to change your GP. If you wish to do this, fill in the section on the front of your medical card and give it to your new doctor; you do not have to have a special reason. If you have any difficulty registering with a GP, you can contact the Patients Services Officer at the above address. They can appoint a GP for you if necessary.

Hillingdon Mind

Hillingdon Mind wishes to ensure that the services we provide are of a good quality and run effectively for the people who use them. If you are unhappy with any of the services the first step is to try to resolve any matter informally with the person concerned. The second step is to involve the Chair of Hillingdon Mind. The third step is to appeal to a specially convened appeals panel. If the problem is still unresolved, you have the right of final appeal to an outside body.

Copies of the full complaints procedure are available from:

Hillingdon Mind, Aston House, Redford Way, Uxbridge UB8 1SZ. 01895 271559

The Mental Health Act Commission

Maid Marian House
56 Hounds Gate
Nottingham NG1 6BG
0115 943 7100
www.mhac.trent.nhs.uk

Any patient detained in hospital under the Mental Health Act has the right to complain directly to the Mental Health Act Commission. Anyone, e.g. a carer or relative, may also make a complaint to the Commission about the use of powers or the exercise of duties under the Mental Health Act.

Your MP

You may also contact your MP, particularly if you feel that you have made complaints elsewhere which have not been properly dealt with.

Contact addresses are available from your local library.

Taking legal action

You should get advice from a solicitor. You may also ask for advice from national Mind’s Legal Department.

Contact 020 8519 2122

Registered Company No. 3009554.
Registered Charity No. 1045701.
Website created by Jason King of HAVS