Setting

This audit is most suited to general adult psychiatry but would also be relevant to other in-patient services.

Background

The experience of being an in-patient is intended to be supportive, containing and fundamentally therapeutic. However, aspects of being a psychiatric inpatient are highly stressful, such as the inability to come and go without restriction. Article 5(1) of the European Convention on Human Rights states that everyone has the right to liberty, but in the case of people who are mentally ill detention may be lawful. Psychiatric staff face difficulties balancing the right to freedom with safety and their duty of care. The practice of locking ‘open wards’ has increased recently, in an apparent reversal of the ethos of psychiatric care over the past three decades, when psychiatry began to move towards unlocked wards and community care (Lancet, 1976).

Section 132 of the Mental Health Act (MHA) details hospital managers’ duty to inform patients detained under the Act of their rights. There is no legal duty to inform voluntary patients but it would be good practice. Rogers et al (1993) found that most informal in-patients felt that they had not received enough information about their treatment. Sugarman & Moss (1994) found that only half of informal patients thought they were legally allowed to leave hospital and only 47% thought they could legally refuse treatment.

Standards

These were based on the European Convention on Human Rights and the Mental Health Act. All patients should:

ᐅ know their status

ᐅ be offered a ward welcome pack. All detained patients should:

ᐅ know under which section they are detained

ᐅ be offered a leaflet and explanation from staff about their rights. All voluntary patients should:

ᐅ have had their rights explained or been offered a leaflet

ᐅ know they have the right to refuse treatment.

No voluntary patients should be kept on a ward against their will without an MHA assessment.

Method

Data collection

All available patients on in-patient wards who verbally consented were interviewed. Those lacking capacity to consent to interview were excluded.

Data analysis

Cases meeting the above standards were expressed as a percentage of the total.