All hospital patients have certain rights, but there are significant differences for behavioral health care. Hospital literature for psychiatric patients explains that you have rights, but also emphasizes that they may be denied. E. Fuller Torrey, M.D., of the Treatment Advocacy Center, believes that laws protecting psychiatric patients’ rights undermine treatment efforts, but attorney James B. Gottstein, who heads the Law Project for Psychiatric Rights, says that protections are minimal and violations are commonplace.
Freedom
To keep patients safe, psychiatric hospitals limit individual freedom and maximize security. A series of locked doors prevent “elopement,” which is psychiatric jargon for escape. Doctors can ask the court to extend hospitalization through involuntary commitment. The U.S. Supreme Court has called this “a massive curtailment of liberty” that requires due process. Legal writers, however, point to deficiencies in the civil commitment process that may lead to rights violations.
Informed Consent
Informed consent is central to patients’ rights. In fact, a doctor who performs a medical procedure without the patient’s approval can be held liable for battery. In psychiatric treatment, however, patients face a presumption of incompetence. Courts have supported doctors who administer medication without explaining risks, benefits and alternatives, and treatment may even proceed over a patient’s objections. These practices trouble many ethicists, who see them as threats to autonomy, self-determination and other fundamental human rights.
Safe Treatment
Patients have the right to be free from potentially unsafe or hazardous treatments, including electroconvulsive therapy and psychosurgery. However, this right is not absolute. Doctors can perform these procedures if they believe the treatment is urgent or medically necessary. They can also use extreme interventions for behavior management, such as seclusion and mechanical restraints.
Privacy
Psychiatric hospitals weigh your right to privacy against the unit’s need for safety. In practice, this means constant surveillance, possibly including closed circuit cameras in your room. Hospital workers say this is necessary to prevent patients from harming themselves or others. Many patients, however, are uncomfortable having cameras trained on them as they sleep or undress.
Property
When you go to the hospital for a physical ailment, you expect to keep your property. In a psychiatric setting, however, certain belongings are deemed “contraband” and locked up. Staff may confiscate a surprising number of items, including spiral-bound notebooks and walking canes. In some hospitals, pens and pencils are off-limits. Investigative journalist Norah Vincent recalls her shock when staff confiscated her pen and gave her a crayon instead.
Other Rights
If you sign in to a hospital voluntarily, you have the right to leave, unless doctors believe it would be dangerous. You have the right to retain a lawyer, and in some cases, a lawyer may be appointed for you. Treatment records are confidential, but a past civil commitment may not be. In most states, you can help protect your rights by preparing an advance directive expressing your wishes for treatment, including whether or not you consent to certain medications and procedures.
References
- “Patient’s Rights Statement”; CareMark Behavioral Health Services; June 2007
- James B. Gottstein, Esq.; President/CEO, Law Project for Psychiatric Rights; Anchorage, AK
- “The Insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers its Citizens”; E. Fuller Torrey, M.D.; 2008
- FindLaw for Legal Professionals: Humphrey v. Cady, 405 U.S. 504 (1972)
- “Alaska Law Review”; Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course; James B. Gottstein; 2008
