human rights and legislation who resource book on mental health

Rights of users of mental health services: Key issues
Confidentiality
• Legislation must ensure patients’ <strong>rights</strong> to confidentiality are respected.
• Legislation should specify that all information obtained in a clinical context (i.e. in the
context of care <strong>and</strong> treatment in any setting) is confidential <strong>and</strong> that all concerned have a
responsibility to maintain confidentiality. This would necessarily include all persons within
facilities <strong>and</strong> services providing care <strong>and</strong> treatment to people with mental disorders.
• Legislation may provide for penalties <strong>and</strong> sanctions for wilful breach of confidentiality by
professionals <strong>and</strong>/or mental health facilities.
• Confidentiality provisions of <strong>legislation</strong> must apply equally to information stored in
electronic/digital format, including national <strong>and</strong> regional databases, as well as <strong>resource</strong>
<strong>book</strong> records containing personal information about persons with mental disorders.
• Legislation may outline the exceptional circumstances when confidentiality may be legally
breached. These could include:
a) life threatening emergencies when the information is urgently needed to save lives;
b) significant likelihood of serious harm or injury to the person concerned or to others;
c) prevention of significant morbidity <strong>and</strong> suffering;
d) in the interests of public safety;
e) when ordered by courts to do so, (in criminal cases, for example).
• Legislation could provide that patients <strong>and</strong> their personal representatives have the right to
ask for judicial review of, or appeal against, decisions to release information.
Access to information
• Legislation should ensure that people with mental disorders have the right to free <strong>and</strong> full
access to their clinical records.
• Legislation should also specify the exceptional circumstances when access to this
information may be restricted (when revealing clinical records may put the safety of others
at risk, or cause serious harm to the person’s mental health).
• The withholding of information should only be temporary, until such time as the person is
more able to rationally deal with the information.
• Legislation could stipulate that patients <strong>and</strong> their personal representatives have the right to
ask for judicial review of, or appeal against, decisions to withhold information.
• Patients <strong>and</strong> their personal representatives may also have the right to request that their
comments be inserted in the medical records without in any way altering the existing
records.
• Legislation (or regulations) may outline the procedure for patients to exercise their right of
access to information
• It is also important that health facilities have a staff member available to review <strong>and</strong>
explain the information that is in the patient’s file or record to the patient <strong>and</strong>/or legal
representative.
Rights <strong>and</strong> conditions in mental health facilities
Legislation should guarantee patients in mental health facilities protection from cruel, in<strong>human</strong>
<strong>and</strong> degrading treatment. In particular, <strong>legislation</strong> may specify that:
a) there is provision of a safe <strong>and</strong> hygienic environment;
b) adequate sanitary conditions are maintained in the facilities;
c) the living environment should include facilities for leisure, recreation, education <strong>and</strong>
religious practice;
d) adequate provision is made for vocational rehabilitation (this would help patients to
prepare for community living once they leave the facility);
e) a right to interaction with members of the same <strong>and</strong> opposite sex;
f) people’s environment is structured so that patient’s privacy is protected as far as
possible;
g) the patients have free <strong>and</strong> unrestricted communication with the outside world,
including receiving visits, letters <strong>and</strong> other communications from friends, family <strong>and</strong>
others (any exceptional situations in which communication could be restricted should
be stated in the law);
h) patients must not be forced to undertake work they do not wish to do, <strong>and</strong> when they
do take up work, this should be appropriately remunerated.
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