Rights Around the World

Announcing: Rights Watch, Around the States and the World

Still in the formative stages: hoping to publish information on rights situations at psych. facilities in other places besides Massachusetts. Please keep me informed of what is happening where you are!

There are some recent actions and events, with news coverage, happening in the District of Columbia, Missouri, and Virginia, and that will be posted soon.

Thanks to all for reading the blog, and keep checking it out!!

A Hospital Story

I'm pleased to present an eloquent account of life on a psych. hospital unit, written by a friend of mine who also lives in Massachusetts...

My Bad Hospitalization Story
by D. Millman

I’ve been in the psych ward of a hospital a few times to date, and hopefully won’t be going again. I’ve had good and bad experiences. Right now, I’d like to discuss the bad experiences.

I never knew that there were any real rights for patients in the psych ward of a hospital – other than privacy laws and such. I’d never heard of the Five Fundamental Rights, as well as the sixth one that’s currently being worked on. I believe in all of them, and of my experiences in the psych ward of my local hospital.

For a little background, I’ve only been in the psych ward of one hospital, but I’ve heard it’s common at other hospitals. All that I can tell you is about my different experiences within the same hospital.

One thing that I noticed right off the bat, during my first hospitalization there was that patients in the psych ward are treated completely different than the other wards that I’ve been in within that same hospital. I found it dehumanizing. The first thing I notice is that only some of the rooms have hospital beds. The majority of them have what I call slabs. They’re wooden and have a slab of something that’s supposed to be a mattress. It reminds me of the gym mats that we used back in elementary school, but thicker. These slabs are not very conducive to people with back problems. In order to get a real hospital bed, you need doctor’s approval, which is almost impossible to get. I’m sure there are beds in prison that are more comfortable.

Also, regarding the beds, no one changes the sheets for you like they do in the rest of the hospital. If you want them changed, you have to change them yourself, which is not exactly high on the priority list of people in the psych ward. Talk about feeling like the “low man on the totem pole” so to speak. Why do we get treated with such low standards? Why are we seen as “less than” all of the other patients? If it weren’t for us, the people working on that unit wouldn’t have a job. Hello people!

Something else that I noticed right away is food ordering. On the rest of the units, you order your lunch for today any time before, say, 10:00 AM. On the psych ward, however, you have to order tomorrow’s food today. If you want food today, you must have ordered it yesterday. If you forget to order, one of the staff has to call down to the kitchen, which they despise doing, and get you the “house” meal – which is whatever they decide to throw on a plate and call a meal. I’m sorry, but if you’re in the psych ward, you’re probably already confused enough, and to have this thrown on there too, well, it’s just very absurd.

The phone is another issue. We don’t get phones in our rooms, so there is no privacy. There are two pay phones on the unit where you can get or make calls. There is only one non-pay phone on the unit, and it’s near the nurse’s station, where there is no privacy. You have to limit your calls to 3-5 minutes, and then it’s someone else’s turn. We’re supposed to keep track of who’s next in line. Yep, that’s another one of our duties. Also, if you answer the pay phone and you need to locate the individual, you do so by running around the whole ward yelling for them. Also, if you can’t locate them, you’re required to take a message, or ask the person to call back at another time. Great, now they made me a receptionist. Hello people!

Showers are not much fun. There are two on the unit, which sometimes has 20-30 people on it. Don’t know whose brilliant idea that was. Oh, there is another one, but there’s a bath there too, and they only use it when they have to bathe people who can’t bathe themselves – since it can be deemed a suicide risk. I’ve never seen it get used. Oops, there is another one, but it’s down in the locked, isolation section, and no one is allowed down there, unless they’re staying in that section of the unit. One stay I did get “privileges” for that shower, because I was having falling down/black-out episodes, and I didn’t want to feel rushed in the shower. Of course, I had to request it numerous times before someone finally agreed that it might be a good idea.

One thing that I’ve found very helpful in my hospitalizations is getting “grounds” privileges. This is where you’re allowed to leave the unit, escorted by staff of course. Sometimes it’s just to go to the gift shop or a walk around the building. Most of the time, if the weather permits, we get to go outside and walk. It’s one of the best parts of being in the psych ward. You get to be outside, smelling the fresh air, which is very good for health – I’ve heard that there are numerous studies that have proven that fresh air is good for your health. It’s the one time you actually get to feel “free”. Most prisoners are allowed to get one hour of fresh air, so should people on the psyche ward. These are the things that many people take for granted, but have it taken away from you, is just horrible.

The psych ward is so dreary, with bland paint jobs that definitely don’t help those of us who are there for depression-related issues. Being outside, sun or not, is just what the doctor ordered. If my hospital, that does all of the horrible things I’ve previously mentioned, can offer this to us, why can’t all of them? I totally agree with the fresh air rights that we should all be allowed.

Results of Blog Poll

Thanks to everyone who took part in the blog poll, which asked people to rate the top 1-5 problems they have noticed in inpatient psychiatric environments.

I set up the poll to be time-limited, so we would have a tangible result. However, your ideas and observations are not only welcome, they are necessary! Please feel free to keep the comments coming, and if you have any ideas for future polls, please let me know.

And now, the results:

PROBLEM AREAS OF MOST CONCERN AT PSYCHIATRIC HOSPITALS:

(Total of 37 people voting)

1.) Staff attitudes, 81% (30 votes)

2.) Boredom/dreary atmosphere, 70% (26 votes)

3.) No access to fresh air, 62% (23 votes)

4.) [Five-way tie for #4] Poor physical environment, 54% (20 votes)

4.) Miscommunication, 54% (20 votes)

4.) Overmedication, 54% (20 votes)

4.) Over-reliance on medication, 54% (20 votes)

4.) Forced treatment, 54% (20 votes)

5.) [Two-way tie for #5] Communication with outside, 45% (17 votes)

5.) Lack of discharge/aftercare plan, 45% (17 votes)

6.) Understaffing, 43% (16 votes)

7.) [Two-way tie for #7] Restraint/seclusion, 40% (15 votes)

7.) Misdiagnosis/medication errors, 40% (15 votes)

8.) Staff inexperienced, 32% (12 votes)

Happy Holidays!!!

Wishing all readers and advocates a very

HAPPY HOLIDAY Season!

May yours be filled by joy and good tidings. We are on the cusp of making change so that ALL people can enjoy the blessings of happiness and community - in full equality. Stay Tuned!!!

Jonathan Dosick
Blog Administrator, "Civil Rights in Psychiatric Hospitals"

Greetings to all!

Please feel free to comment on our POLL. I've created a closing date just to put some parameters on it.

I wish everyone reading a most Happy Holiday season, and I hope that future years will see more humane treatment of us and our friends and family; and a decrease in abuses at inpatient psych units and homes. EVERYONE deserves this much.

Best,
Jonathan Dosick, Blogger

Massachusetts’ Civil Rights Crisis, Part 2 – The Five Fundamental Rights

Second Post – What Violations Look Like

This is the second in a series of posts that describe the ONLY law that protects basic civil rights in Massachusetts - a law that has been forgotten. Violations are the rule, not the exception. This post describes the (commonly seen) violations that do happen.

What do you see in your State or Country?

What Violations of the Five Fundamental Rights (5FRs) law look like:

Sadly, many of these violations are based on reality – they happen on a regular basis.

Violations of Fundamental Right #1 - Access to Telephones:
- Phones are in public places, such as hallways or dining areas.
- Phones are located near or at nurses' stations, so staff can monitor conversations; staff members listen in on calls.
- Calls are kept unreasonably short.
- Phones are shut off (often during ‘groups’); or private phone areas are locked.
- Staff will not provide money/assistance to make calls.

Violations of Fundamental Right #2 - Access to Mail:
- Mail is opened without the patient present.
- Mail is read by staff.
- Mail is opened for any reason beside suspected transmission of contraband.
- Staff refuses to provide writing materials, such as pen and paper, or postage, on request.

Violations of Fundamental Right #3 - Access to Visitors:
- Visiting hours and visits are kept extremely short.
- Visits are only allowed in common areas, such as dining rooms or hallways.
- Staff members are present during a visit.
- Visiting times are not flexible enough to accommodate patients and visitors.

Violations of Fundamental Right #4 - Humane Physical and Psychological Environment:
- Denial of a safe, private space for resting and sleeping.
- Observation by staff while bathing, using the bathroom, or dressing/undressing.
- Placement (esp. in group homes) with roommates who may endanger a patients’ health and wellbeing; staff is insensitive to trauma issues.
- Shared bathing facilities (i.e., group showers or toilets).

Violations of Fundamental Right #5 - Visits with Lawyers and Outside Care Providers:
- Patients can’t receive or refuse visits from attorneys, outpatient physicians, therapists or clergy.
- Staff won’t allow such visits to occur outside of normal visiting hours.
- On admission or on request afterwards, the patient isn’t given information about free legal services, or staff doesn’t help patients in contacting these services.
- An attorney, if given permission by the patient, is denied access to the client, his/her record; or staff responsible for treatment and care. Also, if that attorney isn’t allowed to attend meetings where the client is present.


Violations of Other Provisions of “Five Fundamental Rights” Law:
- The “Five Fundamental Rights” are not posted in a prominent place, or they are hard to understand or read. Non-English speakers can’t have the rights translated.
- A copy of these rights are requested, but staff refuses to provide it.
- Patients can’t wear their own clothes, keep possessions and money, or don’t have private storage space.
- Patients cannot refuse ECT.

LEGAL ASSISTANCE ORGANIZATIONS IN MASSACHUSETTS:

Mental Health Legal Advisors Committee (Boston)

Intake Hours
8:30 a.m. to 1 p.m. - Mondays, Wednesdays and Fridays

Intake LinePhone: (617) 338-2345 press "1" Toll Free Phone:1-800-342-9092 press "1"

Email: MHLAC@mhlac.org

Disability Law Center (Protection and Advocacy agency in Massachusetts)

(Main) Office, Boston:
Phone: (617) 723-8455
Toll Free Phone: (800) 872-9992

TTY: (617) 227-9464
Toll Free TTY: (800) 381-0577
FAX: (617) 723-9125

Western Mass. Office, Northampton:
Phone: (413) 584-6337
Toll Free Phone: (800) 222-5619 Voice
TTY: (413) 582-6919
FAX: (413) 584-2976

E-mail: mail@dlc-ma.org

Center for Public Representation (Newton and Northampton)

Newton, MA Office:
Phone: (617) 965-0776
Fax: (617) 928-0971

Northampton, MA Office:
Phone and TTY: (413) 586-6024
Fax: (413) 586-5711

Email: info@cpr-ma.org

TO FILE AN OFFICIAL (STATE) COMPLAINT BY PHONE, CONTACT:

Disabled Persons’ Protection Commission (DPPC) 24-Hour HOTLINE:

Phone/TTY: 1-800-426-9009


The next post will look into the history of the law, and how and why it is so brazenly ignored.

Massachusetts’ Civil Rights Crisis, Part 2 – The Five Fundamental Rights

First Post – The Five Fundamental Rights Law

The landmark 2000 study “From Privileges to Rights,” published by the National Council on Disability contained these words:

Daniel Fisher, a psychiatrist, testified that some states, such as Massachusetts, had to pass legislation to ensure the human rights of people in institutions who are labeled with psychiatric disabilities, such as the right to make a phone call or have visitors, legislation that would not be necessary if people labeled with psychiatric disabilities did not lose their ordinary citizenship rights.

The law Dr. Fisher refers to is called the “Five Fundamental Rights” law. Sadly, twelve years after its passing, this law is still rarely enforced, and the appeals process is almost nonexistent – leaving thousands with no guaranteed civil rights - in hospitals and group homes.

This post will explain the Five Fundamental Rights (5FR) law. This law applies to Massachusetts only. However, many other states have the same or similar laws and/or regulations. What do you see happening in your State?

In the interest of readability, I am paraphrasing the law, and I’ve added bold type for emphasis. You can read the full language of the law here.


The “Five Fundamental Rights” (5FRs) Law:

Massachusetts General Laws, Chapter 123, Section 23

(As defined by Chapter 166 of the Acts of 1997, An Act Relative to Certain Rights of Persons with Mental Illness):


Rights of persons receiving services from programs or facilities of department of mental health

This law applies to all persons receiving services run or licensed by the Department of Mental Health, including all state and private hospitals, community mental health centers, and/or residential programs. These rights are to be exercised without fear of harassment or reprisal, including denial of appropriate treatment.

(a) The right to reasonable access to a telephone, to make and receive private calls. Assistance making calls must be available when necessary.

(b) The right to send and receive unopened and uncensored mail. On request, stamps and writing materials must be made available in reasonable quantities, as well as help writing and mailing letters.

(c) The right to receive visitors of one’s choice, daily and in private, at reasonable times. There must be some flexibility of visiting hours to accommodate the needs and wishes of individuals and their visitors.

(d) The right to a humane psychological and physical environment, including privacy and security in sleeping, dressing, bathing and toileting. This right does not require individual sleeping quarters.

(e) The right to receive or refuse visits and calls from an attorney, legal advocate, doctor, clergy member or social worker. These calls and/or visits can be outside of normal visiting hours, and can happen regardless of whether or not that person initiated or requested the call/visit.

ACCESS TO ATTORNEYS:
Facilities must give access to attorneys working for Massachusetts’ Protection and Advocacy agency – the Disability Law Center in Boston; the Committee for Public Counsel Services, a State office; and any agency funded by the State’s Legal Assistance Corporation to provide free legal services. The facility must designate ‘reasonable’ times for attorney visits, and provide help in contacting them.

The facility must provide the name, address, and phone number of the legal agencies listed above on admission and on request at any time after.

If an attorney is contacted, and only with consent of the client, the attorney shall have access to:
• The client;
• His/her medical records;
• Staff responsible for care and treatment; and
• Any treatment/discharge planning meetings with the client.


Proposed sixth right:
(Filed as legislation in 2005, 2007 and 2009; to be refiled in 2011.)

(f) The right to daily access to fresh air and the outdoors.


Additional provisions of the law:

POSTING OF RIGHTS
• The Five Fundamental Rights must be posted in appropriate, conspicuous places, in language that is easy to understand. Type size should be readable.
• On request, a copy of these rights must be provided to any client.
• If clients can’t read or understand English, the law must be translated.

ADDITIONAL RIGHTS
• To wear one’s own clothes;
• To keep and use one’s own possessions;
• To keep and use a reasonable sum of one’s own money;
• To have private, individual storage space; and
• To refuse shock treatment (ECT) or lobotomy.

RIGHT TO APPEAL
According to the law, any “dispute” regarding the 5FRs must be documented and “subject to timely appeal.” However (and this is the focus of our advocacy work), the appeals process is badly broken.

Exceptions (But NOT the rule!!!)
TEMPORARY Suspension of Rights

Suspension of Rights #1 (Telephones) and #3 (Visitors):
These exemptions apply only to inpatient facilities and can only be temporary. Suspension may occur only in the following circumstances:
• The suspension is on an individual basis;
• Suspension is issued by a hospital administrator or their designee;
• Suspension can only occur if there is a serious risk of ‘harm’ to self or others. The reason for suspension must be documented, and suspension can only last as long as the potential ‘harm’ exists.
• If use of the phone or visits cause ‘significant disruption’ in the functioning of the unit.

Suspension of Right #2 (Mail):
If a hospital administrator or his/her designee has ‘good cause’ to believe that a patient is receiving ‘contraband’ (i.e., drugs or weapons) through the mail, (s)he may open and inspect such mail.

However, if this is done, the mail must be opened in front of the patient, and staff may not read the mail. The purpose for opening must be documented.

Suspension of Additional Provisions of the Law:
Any of these rights can be denied by hospital administrators or their designees, provided that the reasons for denial are recorded in the client’s record.

What do you see happening in your state or country? Your observations are very important - please post!!!