Understanding Human Rights in Forensic Psychiatric Services: Staff Perceptions of Human Rights Issues in an Inpatient Forensic Psychiatric Service

Abstract

Human rights apply universally to all human beings, however human rights violations have been well-documented in forensic services. Forensic inpatient psychiatric services (FIPS) in the UK occupy a unique position as a healthcare service with obligations to the criminal justice system. This presents challenges in providing patient-centred and human rights-supportive care due to environmental, ethical and legal constraints. In order to understand these challenges and the position of human rights in FIPS, staff were interviewed to explore their understandings of human rights and human rights issues in FIPS. A critical realist epistemological stance was taken and a qualitative research design employed. Eleven FIPS staff were individually interviewed and a thematic analysis was conducted, yielding four key themes: Theme 1: “I Don’t Know an Awful Lot About Them”: Broad Concepts of Human Rights Theme 2: “It Always, Always Comes Back to Risk”: Human Rights in FIPS Theme 3: “Do We Know We’re Violating? Maybe Not”: Human Rights Issues Theme 4: “I Think I-, I’m…Confused”: Tools and Resources in FIPS In seeking to understand staff’s perspectives of human rights in FIPS, this study found that human rights were not widely considered in practice. Practice was predominantly focused around risk and the key legislation considered was the Mental Health Act 1983 (MHA). Both of these factors were seen to justify legally infringing upon human rights, although several practices, lawful under the MHA, were raised as human rights issues, such as restraint and forced medication. Several factors were identified as obstacles to human rights-supportive practice, such as risk management requirements, service culture, and individual practice. However, participants highlighted a need for human rights principles to be integrated into FIPS to improve practice and patient outcomes.