6 VOLUNTARY PATIENTS
6.2 Protection of voluntary patients
In the first NSF(S) response, it was reported that 76% of respondents thought that there should be
legal provision to ensure that people who are vulnerable, but not incapacitated nor detained, should have
their rights respected and views properly taken into account. Many of these respondents went on to give
their views on why safeguards are needed and on suggestions of what these should be. The strong views
expressed in some cases reflect peoples' perception of treatment. There was no real difference between
service users and informal carers.
Almost all thought,-that the service user needed a 'supporter' when treatment was being considered.
This supporter could be a trained advocate, family/friends, GP, MHO, key worker, legal expert or
psychologist, preferably someone known to the patient. That supporter should meet with the consultant
and the patient.
An advocate was repeatedly mentioned.
- 'an advocate would ensure that there is
provision for the client's views to be heard'
- 'basically advocacy and advice away from the
intimidating environment and assurance that the advocate will remain on the side of the patient and be
present or on call at all important decision-making times'
- 'involvement of advocate and strengthening
the duty of staff to report to the consultant any sign that the person is not freely consenting'
- 'independent advocacy will ensure that all
options for treatment are considered'
Carers should also be consulted.
- 'carers may be able to monitor user's rights in
some cases. Certainly the service user should have a 'concerned adult' present when they disagree with
the treatment-awkward but only fair'
- 'relatives should be involved where consent is
not freely given'
Advance directives could be very helpful in future treatment.
Respondents also commented on what rights the patient should have.
- 'patients should have the best drugs available.
Their views should be taken into account if they object if they object to a particular drug and ask for a
similar but less debilitating drug unless there is real clinical objection. Only a patient truly
knows/experiences the full effect of anti-psychotic drugs'
- 'right to refuse ECT if person peaceable'
- 'no one should be discharged without having
accommodation arranged and that should not be bed and breakfast accommodation. Need more help
with finance budgeting, savings, benefits'
- 'more monitoring of vulnerable patients by
MWC, more information on rights and consent should be given to users and carers'
Several people emphasised that professionals should not use coercion, and consent should be
freely given. Time should be given to build up trust.
- 'they should not lie or con the patient. It
is counterproductive'
- 'how long is a person truly a voluntary
patient?'
- 'should be a basis of trust with no
threats e.g. person being told they'll be compelled to stay in hospital for 6 months, 1 year
etc'
- 'pressure should not be put on to
accept ECT etc. The answer "No " should be respected'
- 'if person is in a reasonable state of
mind, they should not be forced by a threat of sectioning'
- 'all consent to treatment should be in
writing'
- 'professional training should show
that blackmail is wrong. Time should be given to build up trust'
- 'should be time for user to come to terms
with their immediate situation and their vulnerable position'
- 'people should be allowed 'thinking
time' away from professional pressure to do something'