Restraining Good Practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK)

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman or degrading treatment, and having the right to liberty, security, respect and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature findings revealed restraint can be a form of abuse, it’s inappropriate use often being a consequence of fear, neglect and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike

Deprivation of Liberty of Children

International children’s rights law is utterly clear. The use of deprivation of liberty of children must be limited to the absolute minimum. If it is nevertheless regarded necessary to arrest, detain, imprison, or institutionalize a child, states have the obligation to safeguard that her or his rights are recognized and adequately protected, regardless of the context in which the deprivation of liberty takes place. This chapter elaborates on the specifics of these two limbs of Article 37 CRC, the core human rights provision for the protection of children deprived of liberty. It analyzes the legal status these children are entitled to, specifies the corresponding negative and positive obligations for states, and explores avenues for an effective implementation.Effective Protection of Fundamental Rights in a pluralist worl

Migrants, State Responsibilities, and Human Dignity

This article addresses two questions: First, how does the value of human dignity distinctively bear on a state’s responsibilities in relation to migrants; and, secondly, how serious a wrong is it when a state fails to respect the dignity of migrants? In response to these questions, a view is presented about the distinction between wrongs that violate cosmopolitan standards and wrongs that violate the standards that are distinctive to a particular community; about when and how the contested concept of human dignity might be engaged; and, elaborating a three-tiered and lexically ordered scheme of state responsibilities, about how we should assess the seriousness of a state’s failure to respect the dignity of migrants

Tysiac v. Poland, Appl. No. 5410/03

Este caso relata sobre una mujer polaca de 29 años, padeciendo de miopía severa. Pidió autorización de interrumpir su embarazo ya que percibía que su salud se estaba deteriorando. Un médico general consideró medicamente indicada el aborto pero los demás médicos consideraron que su salud no estaba en riesgo. No obstante, la mujer se quedó ciega después del parto. Se hizo una demanda ante La Corte Europea de Derechos Humanos que determinó que la imposibilidad de acceder al procedimiento tanto como la ausencia de mecanismos que permitieran controvertir las decisiones de los médicos, habían afectado, entre otros derechos, la integridad física de la mujerhttp://www.unhcr.org/refworld/docid/470376112.htm

Do-not-attempt-cardiopulmonary-resuscitation decisions : an evidence synthesis

Background: Cardiac arrest is the final common step in the dying process. In the right context, resuscitation can reverse the dying process, yet success rates are low. However, cardiopulmonary resuscitation (CPR) is a highly invasive medical treatment, which, if applied in the wrong setting, can deprive the patient of dignified death. Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) decisions provide a mechanism to withhold CPR. Recent scientific and lay press reports suggest that the implementation of DNACPR decisions in NHS practice is problematic. Aims and objectives: This project sought to identify reasons why conflict and complaints arise, identify inconsistencies in NHS trusts’ implementation of national guidelines, understand health professionals’ experience in relation to DNACPR, its process and ethical challenges, and explore the literature for evidence to improve DNACPR policy and practice. Methods: A systematic review synthesised evidence of processes, barriers and facilitators related to DNACPR decision-making and implementation. Reports from NHS trusts, the National Reporting and Learning System, the Parliamentary and Health Service Ombudsman, the Office of the Chief Coroner, trust resuscitation policies and telephone calls to a patient information line were reviewed. Multiple focus groups explored service-provider perspectives on DNACPR decisions. A stakeholder group discussed the research findings and identified priorities for future research. Results: The literature review found evidence that structured discussions at admission to hospital or following deterioration improved patient involvement and decision-making. Linking DNACPR to overall treatment plans improved clarity about goals of care, aided communication and reduced harms. Standardised documentation improved the frequency and quality of recording decisions. Approximately 1500 DNACPR incidents are reported annually. One-third of these report harms, including some instances of death. Problems with communication and variation in trusts’ implementation of national guidelines were common. Members of the public were concerned that their wishes with regard to resuscitation would not be respected. Clinicians felt that DNACPR decisions should be considered within the overall care of individual patients. Some clinicians avoid raising discussions about CPR for fear of conflict or complaint. A key theme across all focus groups, and reinforced by the literature review, was the negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’. Limitations: The variable quality of some data sources allows potential overstatement or understatement of findings. However, data source triangulation identified common issues. Conclusion: There is evidence of variation and suboptimal practice in relation to DNACPR decisions across health-care settings. There were deficiencies in considering, discussing and implementing the decision, as well as unintended consequences of DNACPR decisions being made on other aspects of patient care. Future work: Recommendations supported by the stakeholder group are standardising NHS policies and forms, ensuring cross-boundary recognition of DNACPR decisions, integrating decisions with overall treatment plans and developing tools and training strategies to support clinician and patient decision-making, including improving communication. Study registration: This study is registered as PROSPERO CRD42012002669. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Counter-extremism in British schools: Ensuring respect for parents' rights over their children's religious upbringing

The UK Government’s PREVENT strategy to counter radicalisation and extremism has been the subject of criticism. Concerns arise over clarity of purpose, clarity of terminology used and potential human rights impacts. Where the policy engages with schools, one human right potentially engaged is the right of parents to transfer their religious beliefs to their children. This paper looks at how PREVENT risks negatively impacting on this right. It proposes a way that this risk can be reduced by adopting a proactive approach to the Government’s security concerns which is centred on human rights education

Freedom of expression : essays in honour of Nicolas Bratza /

Also published by the Council of Europe and the European Court of Human Right