Overview of the Winterbourne View Case - Essay Example

WINTERBOURNE VIEW CASE By Winterbourne View Case Overview of the Winterbourne View Case The Winterbourne view case was an incidence of hospital abuse that occurred at Winterbourne view, a private hospital at Hambrook, South Gloucestershire, in England. In this case, it was revealed by a television investigation that patients who suffered from learning disabilities and challenging behaviour in the hospital were exposed to physical and psychological abuse by the hospital staff. The investigation revealed that the hospital’s patients underwent such inhumane treatment as being, repeatedly, assaulted and harshly being restrained under the chairs (Flynn, 2012). Other forms of abuse included being forced to take cold showers, left alone in near zero temperatures outside the hospital facilities and mouthwash being poured into their eyes. As well, staff could be seen in the footage pooling the patients’ hairs as they forced to take medication, paying no attention to the patient’s screams and yells. In one bizarre incident in the footage, a patient attempted to jump from a second floor window to evade the torment (Flynn, 2012). Mental Health Act 2007 In England, the Mental Health Act of 1983 (substantively amended in 2007) is the main legislation that governs the admission, assessment and treatment of patients with mental health illnesses in England and Wales (Dow, 2008). This law allows people with “with mental disorders” to be admitted, detained and treated without their consent in approved hospitals within the said countries. This law is premised on the need, to ensure the patients’ safety, as well as the safety of other people. Under the Act, different patients are admitted, detained and treated under different sections of the act depending their unique cases and circumstances giving rise to the famous concept of “sectioning” where each section of the Act governs different circumstances. The Mental Health Act 2007, provides six sections that govern various stages of treating the mental health illnesses. Section 2 governs the detention of patients brought to the hospital for assessment and treatment. For a patient to be placed under this section, an application has to be made to the hospital by two doctors and an Approved Mental Health Professional (AMHP) (The Mental Health Act, 2007). A senior doctor referred a responsible clinician is put in charge of the patient’s care and treatment. People admitted under section two can be kept in the hospital up to 28 days. This section is not renewable and as such, health professionals wishing to extend the detention period are required to do so under section 3 of the Act. Section 3 allows patients to be admitted and be detained in approved hospitals for up to six months for treatment purposes. The decision to put a patient on section 3 is the responsibility of two doctors and an Approved Mental Health Professional. If under section 3 and a patient wishes to leave the hospital he/she has a right to receive aftercare (guaranteed under section 117). This is free of charge, and it is designed to help with a patient’s mental health needs as he/she goes back to the community. Under section 3, the patient has the freeway to discuss with the responsible clinician the option of leaving the hospital under the Supervised Community Treatment Plan, sometimes known as the community treatment order (CTO). Under this plan, the patient must continue having treatment within his or her community and may be brought back to the hospital on the hospital’s recommendation (Department of Health, 2007). Section 4 of the Act is applied in emergencies or crisis situations when there is no enough time to admit a patient under section 2 or 3. This section authorises an approved mental health professional to admit and detain a patient considered to be in an emergency situation for up 72 hours. During this period, a second doctor is required to review the patient and put him/her under either section 2 or 3. Section 5 (2) is used to hold a patient who originally came to the hospital as an ‘informal’ or ‘voluntary’ patient but now the hospital considered for admission instead of being given permission to leave. Therefore, the patient is admitted under this section as he/she awaits admission under section 2 or 3. Section5 (4) is used to admit a patient of the above circumstances by a nurse in the absence of a doctor. These section loads up to 6 hours nod end when the doctor comes to see the patient. Although used very rarely, section 136 allows a police officer to take a person from a public place to a place of safety based on the officer’s judgment of the person’s situations (The Mental Health Act 2007). A detained person loses some liberties for example freedom of movement and freedom of association as a compromise so as to guarantee his/her owns safety and the safety of people around him/her. However, the patient enjoys the right of appealing, against the decision, to detain him/her to a Mental Health Tribunal (MHT) or the hospital’s managers. As well, the patient reserves the right to obtain the services of an independent mental health advocate if not convinced of the detainment. This safeguards one of the most important human rights, that is, "the right that no one shall be subjected to arbitrary arrest, detention or exile" (Jorm et al., 2000). The Human Rights Angle to the Case In the Winterbourne view case, various human rights of the patient were breached. The first of these rights was the right to anti-torture or inhumane or degrading treatment or punishment as provided by Article 3 of the European convention on human rights (Gostin, 2000). This right was clearly abused when the patients were physically abused for example by being pushed around and poked around. The patients also suffered emotional abuse by being detained under chairs and being shouted at. The failure to deny access to family members and friends to patients’ bedrooms denied them their source of emotional support, hence amounting to inhumane treatment. All these activities amounted to torture and inhumane treatment, a grave breach of such fundamental human rights. Another key breach of fundamental human rights is the right to privacy and family life as provided in Article 8 of the EU convention on human rights (Bindman, Maingay& Szmukler, 2003). This right provides for respect for a person’s private and family life as well as his/her home and his/her correspondence. This right guarantees that there should be no interference by a public authority on the exercise of this right unless under circumstances specified by law. The patient’s public torture and humiliation in front of the hospital staff amounted to clear breach of this right (Heron, 2011). It is possible that a patient was unlawfully denied their rights to liberty and security since the circumstances of their admission and detention for treatment were unclear. It is also a possibility that patients who were supposed to be released had their stay extended to the hospital and hence breaching their right to liberty. Indeed, the review carried out by the department of health found out that patients overstayed at Winterbourne view and they were too far from home (Flynn, 2012). The role of the Police and the Local Authority The involvement of the local detective officers and other agencies in Winterbourne view case was largely ineffective and failed to fulfil their core mandates of protecting the vulnerable patients from abuse in the hospital. Various cases were noted from various reviews where police failed to take action on cases of abuse reported to them when they were required to do so (Lamb, Weinberger & DeCuir Jr, 2014). From the serious case reviewed by Margaret Flynn, a case is highlighted where on the 16th of March, 2008 a patient alleges assault from a staff member. The staff member is the suspended by the hospital management and an investigation completed, whose report is the handed, to the police, to execute. The police fail miserably on this front as they only interview the accused staff member and take no action preferring instead to pass the case back to Winterbourne View. Another case reported on the 29th of April, 2008 reveals a patient to patient assault. Although there is a record of multi-agency involvement in the investigation, the process is completed without formal police investigation. The final decision about the case is made by a Public Protection Unit (PPU) investigator in consultation with a doctor in the hospital. On the 19th of June, 2008 an incidence is recorded in which a staff member is assaulted by a patient during restraint. The crime is not fully investigated as the staff member apparently reported it for purposes of record keeping only. A police incident report on the 26th January, 2009 reveals a record of assault by a staff member by a patient through a phone call from Winterbourne view hospital. In their investigation, police offices only engage the member of and the manager but not the patient. Although the victim had suffered some serious injuries through bites and scratches, no further investigation is carried out and the case is not conclusively determined. On 26th August, 2009 a patient who had been earlier assaulted, was assaulted again by a staff member. Although the police were involved, in this case, the review indicates that the case does not appear to have been investigated by the Public Protection Unit. All the above specific cases point to the overall failures of the police as a critical agency that is required to investigate and determine cases of abuse within such environments (Lamb, Weinberger & DeCuir Jr, 2014). From the various reviews, it has been established that the South Gloucestershire Council under whose jurisdiction winterbourne view hospital fell was dismally ineffective in monitoring and bringing to the fore the various cases of abuse at the hospital. The stated mandate of safeguarding adults’ policy was to safeguard all adults resident is South Gloucestershire. Despite this, the reviews indicate that the council failed in this respect by deferring its mandate to the detective officers, even though, it was clear their mandate cut across various professions and organisations. The council also failed to take action on some very serious cases that were reported to it when its mandate was clearly to coordinate and consult on safeguarding activities around such cases (Flynn, 2012). The reviews indicate that, South Gloucestershire’s safeguarding and procedures were applied inconsistently to the hospital and investigation management was sometimes found to be poor. Various cases are revealed where Winterbourne View Hospital managers were required to investigate various allegations and report their findings to the council’s Adult Safeguarding arm. However, the hospital management ended up failing to submit most of the reports, and there was no specific mechanism by the council to make sure that this happened (Flynn, 2012). Clearly, the council failed dismally in its important role of providing a safeguard for the patients against patient abuse. The Whistle-blower and the Care Quality Commission Although whistle-blowing was done in the form of the e-mail sent to the management of the hospital, the response given from the hospital in terms of tangible action was disproportionately limited. Had the management acted sufficiently to the insights given by the whistle-blower, the abuse might have been limited in scope. The Care Quality Commission is an independent controller/regulator of the health and adult social care services provided in England (Care Quality Commission, 2013). The Commission has a further mandate of protecting the rights and interests of persons with restricted rights under the Mental Health Act (Care, 2013). The commission has a mandate to regulate health and social car5e services provided by all providers in England, be it the publicly-funded NHS, private companies or voluntary organisation. In the wake of the BBC expose, the CQC carried out both a compliance review and an Internal Management Review of the Winterbourne View Hospital regulator. The compliance review found out that the hospital failed to comply with at least ten essential standards leading to the commission’s action of de-registering the company. A critical analysis of the review reveals that the Care and Quality Commission failed in its role on a number of fronts. It has to be understood that any systemic failure’s within the hospital directly translated to failures of the Commission as it has the sole mandate of regulating all healthcare provider’s to ensure their compliance with set standards. The essential metrics on which the hospital failed to meet compliance reflected the wide areas of regulation in which the commission failed. The first area of the commission’s failure was the inability to put in place an effective inspection regime that would ensure the hospital’s compliance with the set standards. This gave rise to a situation where risks related to self-harm had not been assessed and as well not all staff had received training on first aid as the hospital claimed in its records. On the criteria of safeguarding the people who use the service, the review found out that the hospital staff unjustifiably used forceful restraint when it wasn’t necessary to do so (Dale & Ryan, 2011). The management of medicines at the hospital was found to be wanting as there were incomplete records on the available medicines and their use. These are some of the key failures of the Commission that were well reflected in the systemic failures within the hospital system itself (Flynn, 2012). The Serious Case Review The Serious Case Review highlights various issues that need serious attention in order to improve how mental health patients are treated. The unique aspect of the Winterbourne View case is that it reported abuse and mistreatment of patients, even though, it was not short of funding as contrasted with the NHS hospitals (Care, 2012). This is because the hospital was able to raise enough revenue of its own from the fees it charged (Flynn, 2012). One of the key highlights of the case was the failure of the NHS commissioners to execute a full control of the Winterbourne View facility in terms of understanding its operations and accountability. They continued sub-contracting the hospital to take care of adults suffering from learning disabilities and autism while all along without knowledge of how the hospital ran its systems (Flynn, 2012). This gave the facility a loophole to earn its revenue while failing to provide quality care to its clients. This was a major failure on the NHS on the model of public-private partnerships in the provision of quality healthcare (Care, 2012). Another key highlight is the recommendation that planning should support local strategies that are aimed at improving the health, as well as social and cultural wellbeing of the people (Northway & Jenkins, 2012). This should be premised on the principle of localising planning so that local needs and initiatives are integrated into decision making as proposed in the National Planning Policy Framework of March 2012. Another key highlight would be the unplanned growth of assessment and treatment of adults with learning disabilities as long-term solutions to these problems (Northway & Jenkins, 2012). This is because these assessment and treatment units are not well designed with enough capacity to become long-term solutions to the problems they handle and would barely serve as a stop-gap measure to a much deeper problem (Flynn, 2012). Finally, another key highlight of the case would be how local community services would help people with learning disabilities and autism heal and lead normal lives again if they experienced the kind of treatment they went through at a place they were meant to receive quality and restorative care. Local communities services need to give serious consideration to coming up with mechanisms to of providing truly quality care for this group of vulnerable people (Flynn, 2011: 2012) The Mental Capacity Act and the Equality Act Both the Mental Capacity Act and the Equality Act are of immense relevance to cases similar to that of Winterbourne View. The Mental Capacity Act is designed to protect and empower patients who may lack the capacity to make their decisions due to limitations arising from their mental health condition (The Mental Capacity Act, 2005). The key formulations of this Act is that a person reserves the right to make all decisions regarding their lives and this right must never be withdrawn until it can be proved that they lack this capacity to do so (Shickle, 2006). Even in such cases, the patients should be first helped to make decisions before making decisions on their behalf is justifiable; when they have to make decisions on their own, they should be in their best interests. In the case of Winterbourne View, it can be clearly be observed that provisions in this Act were not taken into consideration and patients were forced into decisions that were not in their best interests, for example, the forceful restraints, and the forceful commands to take cold showers against their wills (Boyle, 2008) The Equality Act 2010 was enacted to protect people from any form of discrimination in the workplace and the wider society. This Act criminalises any form of discrimination on any basis, including on the basis of one’s mental health Act, 2010). The legal implication of this law is that both public and private health providers found to engage in any form of discrimination like that experienced at the Winterbourne hospital can be held accountable before the law. This would go a long way in encouraging mental health services providers to respect and uphold the dignity of the patients brought before them (The Equality Act, 2010). Beyond Winterbourne View The case of Winterbourne View rose to the centre of the national psyche and swung the responsible institutions and agencies into action to re-evaluate and re-orient mental health care to be more humane and of more quality. The Department of Health designed a raft of new policy directives that were aimed at making mental health care services providers more accountable, better regulated as well as engaging in best practice in the sector (Anonymous, 2011). As a result, significant improvement was seen in this category of services makes modern patients less likely to undergo what was experienced at Winterbourne View. In the area of safeguarding vulnerable adults from abuse, a raft of new policies have been put in place by various local councils in order to ensure more protection based on new legislation, research and growing expertise in the mental health care sector. Some of the initiatives and policies put in place include: multi-agency co-operation in order to better pre-empt or punish abuse, taking a proactive approach to minimizing abuse, having robust systems in place that ensure staff are familiar with the safeguarding policies in place which makes them more likely to respect and uphold them, auditing and constant evaluation of service providers to ensure they are upholding the set standards, collecting more data to guide decision making and policy interventions, among others (Oakes, 2012). Bibliography Act, E., 2010. Equality Act 2010. The Equality Act. Anonymous, 2011. "Assessment of Mental Capacity: A Practical Guide for Doctors and Lawyers." The Journal of Adult Protection 13, no. 2: 114-115. Bindman, J., Maingay, S., & Szmukler, G. (2003). The Human Rights Act and mental health legislation. The British Journal of Psychiatry, 182(2), 91-94. Care Quality Commission, 2013. Our safeguarding protocol. The Care Quality Commission’s responsibility and commitment to safeguarding. Care Quality Commission. Care, T., 2012. A national response to Winterbourne View Hospital. Department of Health Review: Final Report. Dale, C., & Ryan, T., 2011. An ever watchful eye: The Care Quality Commission’s inspection regime failed to protect patients at Winterbourne View. Colin Dale and Tony Ryan suggest an alternative approach. Learning Disability Practice, 14(8), 9-9. Department of Health, 2007. Mental Health Act 2007. Dow, J., 2008. Mental Health Act 2007. Journal of Integrated Care, 16(2), 33-37. Flynn, M., 2011. Winterbourne View Hospital: Serious Case Review South Gloucestershire Safeguarding. Flynn, M., 2012. Winterbourne View Hospital: A serious case review. South Gloucestershire Adult Safeguarding Board. Gostin, L. O., 2000. Human rights of persons with mental disabilities: the European Convention of Human Rights. International Journal of law and Psychiatry, 23(2), 125-159. Heron, C., 2011. Hidden in plain sight: inquiry into disability-related harassment. Jorm, Anthony F., A. E. Korten, P. A. Jacomb, H. Christensen, B. Rodgers, and P. Pollitt., 2000. "Mental health literacy." British Journal of Psychiatry 177(5): 396-401. Lamb, H. R., Weinberger, L. E., & DeCuir Jr, W. J., 2014. The police and mental health. Northway, R., & Jenkins, R., 2012. Must do better: the lessons to be learned from Winterbourne View: Ruth Northway and Robert Jenkins provide a historical context to the events at Winterbourne View and argue for greater vigilance in community settings. Learning Disability Practice, 15(8), 26-28. Oakes, P., 2012. Crash: what went wrong at Winterbourne View?. Journal of Intellectual Disabilities, 16(3), 155-162. Shickle, D., 2006. The mental capacity act 2005. Clinical medicine, 6(2), 169-173. The Equality Act 2010. Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents [Accessed 6 March 2015]. The Mental Capacity Act 2005. Available at: http://www.legislation.gov.uk/ukpga/2005/9/contents [Accessed 6 March 2015]. The Mental Health Act 2007. Available at: http://www.legislation.gov.uk/ukpga/2007/12/contents [Accessed 6 March 2015]. Read More