The state or province in which you are currently residing governs facilities psychiatric patients may be institutionalized in with strict controls and legislation.  Each and every state/province will have differing policies on the maintenance of its own psychiatric establishments, but there will be nation wide controls and acts that preside over the humane treatment of all psyche patients and their care.  In my research of this subject it appears that in both countries, the U.S.A and Canada, the literature on patient’s rights is very similar.  I gained most of my information from patient rights information kits that are given out upon admission to a hospital psychiatric ward.  I also delved into a few legal minds; I must say they were quite lovely and patient with my incessant questions, as well as being very helpful in allowing me to grill them on the subject. 

Now, I must preface this section by stating that I am not a legal professional and the material I am about to disclose is not a formal official document.  If you wish to know the precise rights and legal legislation for your area concerning psychiatric institutions and hospitalizations approach a Mental Health Advocate, or ask your attending in-hospital psychiatrist for a copy of patient rights.  They must oblige and inform you of your rights.   

Above all, the humane and ethical treatment of all patients is the prime objective of all legislation concerning psychiatric care.  The second objective one notices is the focus on a patient’s right to appeal his/her admission to or treatment in hospital.  And, of course a patient’s right to privacy is explicitly stressed and protected by the laws of both countries, Canada and the U.S.A. (And, I am quite sure this is so in most other countries as well.)  The remaining rights a person comes across deal mainly with the involvement of a patient in his/her own care and the release of medical information to him/her if he/she should require it.  In the following text I will endeavor to inform you of and explain some of a patient’s rights when a person is hospitalized, whether they are voluntarily or involuntarily admitted.

Most patients admitted to psychiatric institutions do so under voluntary terms.  They seek treatment for their illness of their own volition and their status is considered as voluntary.  Sometimes, however, people require admissions who do not wish treatment, whether it be because they feel it is not necessary or they are too ill to know better.  In this case, when these people are brought in to hospital they are admitted under an involuntary status.  A psychiatrist will assess a person once they are brought into the hospital.  Once they have made a preliminary examination of that person’s mental health and concluded hospitalization is in order it will then be decided what form of admittance status the patient will have.  At this time the admitting practitioner must inform the person as to whether he/she has voluntary or involuntary status. 

If a person vehemently objects to involuntary admittance and wishes to contest the issue they have the right to seek legal advice and aide through a Mental Health Advocate/Legal Representation.  The hospital must provide access to some form of representation on behalf of the patient.  Now, if a person is admitted under voluntary status, but wishes to be released from the institution in which they are hospitalized against the better judgment of his/her physician, he/she has the right to do so.  The person is required, however, to give his/her attending psychiatric staff  24hours notice and sign a legal form requesting leave against medical advice.  If a voluntary patient is exhibiting highly dangerous behavior and a physician is concerned for their personal safety or that of others, (or they may be regressing in their illness to the point of incapacitation) the patient may be involuntarily committed at that point.  A patient in this situation still has the right to contest his/her hospitalization. 

A patient is entitled to access information concerning his/her healthcare.  A person has the right to be educated on the nature of the procedures practiced upon him/her, the medications prescribed and administered to him/her, and the primary objectives of the forms of therapy he/she is subjected too.  A patient has the right to be made aware of any changes in his/her treatments or medications.  He/She should be informed of all test/therapy results no matter the outcome, be they negative or positive; a patient has the right to know their progress.  He/She also has the right to access any and all medical records.  The problem with access to medical records is; there are some situations in which they will not be released unless there is a physician present to “translate” the document for you.  The physician can charge a sitting fee of any amount and it can become quite costly if it should take time to read through complicated information.  Physicians must inform a patient on the current prognosis of his/her illness and keep him/her up-to-date on their condition.

Every patient, whether voluntary or involuntary, has the right to object to treatments, procedures, medications, and contact with certain staff members, as well.  A patient has the right to refuse treatment for whatever reason he/she may have whether it may be his/her beliefs or understandings of the said treatment that may cause him/her to object.  He/She has the right to refuse treatment from certain mental health practitioners and institutions.  A patient has the right to refuse a mental health practitioner access to their person, whether it is a physician or a nurse.  He/She can insist upon a second opinion from a neutral party; another physician from a different hospital.  He/She can also insist that he/she receive treatment from a different therapist or physician than from the one that is presently attending to him/her.  The patient can demand that his/her attending physician seek alternative treatments to the one he/she finds offensive or ineffective.  The institution must endeavor to provide for the patient’s care with great concern for his/her wishes or provide him/her access to another hospital that will be able to more capably comply with his/her demands.  If a patient, whether voluntary or involuntary, feels that they have been restricted in these rights he/she has the right to appeal to the Mental Health Review Board (or an equivalent monitoring body).  The hospital must provide the patient access to a representative or some form of patient advocacy. 

It is a patient’s right to participate and be an involved party in the progress of his/her therapeutic care.  He/She should be allowed to be able to participate in the development of his/her therapeutic considerations. He/She should be continually referred back too when assessing his/her therapy and progress. A patient has the right to be made aware of important decision making processes, physician/family meetings, and any other developments that may occur during his/her hospitalization.  He/She has the right to discuss the pros and cons of medication changes or procedures with his/her doctor.  The physician is the professional mental health provider, but the patient is the one who is receiving the treatment and has the right to consent to it or not.  A patient also has the right to leave an institution if he/she feels that the care provided is not adequate or is no longer having a beneficial therapeutic effect.

Every patient has the right to a safe clean environment in which they are to be hospitalized.  A patient must be afforded every dignity possible in an institution.  This means that a patient has the right to care that is free of prejudice, sexual harassment, exploitation, and physical/emotional/sexual abuse.  A person has the right to feel safe and secure in the care of the medical staff attending to him/her.  A patient must feel that his/her care is being provided by a capable and able healthcare provider.  A person should believe that his/her care is being provided by skilled and appropriately trained individuals.  He/She should feel secure that he/she is receiving therapeutically appropriate treatment that has been specifically devised for his/her care.  He/She should be able to comment on his/her treatment if it should become inappropriate.  He/She has the right to approach staff supervisors or hospital advisory committees if there is behavior that warrants reproach/unsanitary or unsafe conditions.  All patients have the right to be treated in an ethical and humane manner by staff upholding professional work practices.  These professional healthcare workers must display a respect for every patient’s religious/ethnic background and treat him/her in a manner that upholds his/her dignity and self-respect.    

A patient has the right to confidentiality both in the form of written medical records and also in the actual physical privacy of person on the psyche ward.  When it comes to a person’s medical records, they are protected by law and cannot be revealed to anyone, not even family members, without your express written permission.  A patient’s confidentiality can only be broken in very specific circumstances, such as these:

(These circumstances may differ from state/province to state/province and country to country.  I am, by all means, not the final word on the law concerning this matter; I would suggest a person seek a legally appointed advocate to learn more information.)

A person has the right to expect privacy during his/her hospitalization.  This means that there is an expectation on the part of the patient that all matters concerning his/her care will remain confidential.  All staff is required to refrain from discussing any patient information outside of the hospital psyche ward.  You also have the right to the privacy of your person; you must be allowed personal space in which to conduct washing up and changing in privacy.  Unless a patient causes the attending staff harm or the belief that he/she may harbor dangerous objects in his/her possession, a patient has the right to the privacy of his/her personal allotted space from being impinged on by staff searches.  Personal correspondence and writings should also fall into the category of privacy, unless the patient uses it as a malicious weapon towards another party, the content is suicidal in nature, or it discloses information about a criminal act. (Privacy issues involved in some of these materials can only be broken if the party that created the material divulges its content to another.)

• If a person is pregnant physicians may or may not honor her wishes while incapacitated and in their care.  If they feel the patient should become a danger to herself or the child. They may specialize treatment due to certain conditions; how many months pregnant a person is (during the 2^nd and 3^rd trimesters doctors are likely to be extremely conscious of the wellbeing of the fetus), the risks treatment may pose to the patient and the fetus, and the policies of the individual doctors and institution involved in the patient’s care.