'Knocking Out - Violence and Aggression in
Health Care'
Friday 2 November 2012
It is my privilege to address you during this
conference on violence and aggression in health care. I would like to thank MAPN for organising
such an important and relevant conference.
Mental health professionals do encounter
violence, aggressive and challenging behaviour. Probably the perception is that
we encounter much more aggression than we actually do. I fully endorse any
measure aimed to protect mental health professionals from any aggression. It is
a fact that such incidents are frequently caused by a minority of
patients. There are ways how to effectively
minimise such occurrences or to limit the extent and duration of such
behaviour.
In fact, earlier this month intensive
training was conducted for 14 mental health professionals to acquire
internationally-accredited certification in the use of de-escalation techniques
for the management of conflict situations. Furthermore, these persons are now certified trainers. They will now lead and train all MCH
personnel in the use of these techniques in situations of conflict and
potential aggression.
This training programme consisted of a
theoretical part which focused on verbal de-escalation strategies. It also included a practical part which
focused on the safe, humane and respectful physical techniques which are to be
used in situations where physical aggression is present.
These internationally certified methods
are tailor-made for the psychiatric setting. This training will continue to
consolidate the ever rising standards of care within the Maltese psychiatric
facilities.
By going
through the programme I have noticed that the subject of aggression towards members
of staff will be dealt with in certain detail. So allow me to expose a
different perspective to the topic under discussion. I want to give the
patient’s perspective on violence and aggression.
I ask you, “Are patients occasionally victims of
violence and aggression?” Fortunately instances of violence on patients by
health professionals are not a common occurrence. I can vouch that the vast majority of mental
health professionals treat their patients very well and strive to protect them
and advocate for their rights. Very
frequently I meet patients who are being treated at Mt Carmel Hospital or
clients who are being cared for in the community who come up to me to tell me
that they are receiving optimal care. Most of them refer to members of our mental
health care professionals as their friends and many, in fact look up to them as
their role models. I commend you for the
excellent care that you are giving to our patients.
Yet we cannot ignore the fact that there are
instances where mental health patients experience violence and aggression from
their relatives, legal guardians and custodians.
As you know, violence is not only physical,
psychological or emotional abuse, but also encompasses the violation of one’s
fundamental civil and human rights. Such rights are often trampled upon by
society through stigma, discrimination and marginalisation.
Even our current mental health act tends to
ignore the patients’ rights. In our current legislature the patient has no
voice. He has no influence on his care plan.
The patient encounters various barriers to seek readdress when he feels
that his/ her rights are jeopardised. The current law is based on the medical
model, where only psychiatrists have a role to decide on what is best for the
patient. The patient is just a passive recipient of care. Even other health
professionals have no legal right to decide on the patient’s welfare – a far
cry from the concept of multidisciplinary care.
This archaic legislation is now being revoked and a new act is being enacted. I hope that will be able to start discussing
in Parliament the new Mental Health Act will within a few weeks.
The new act is based on safeguarding human
rights. It puts the patient at the core of our activity. It gives an effective
voice to the patient to actively participate in his care plan. Patient participation will now be mandatory. Every
patient has a fundamental right to agree and consent to any treatment offered. Such an approach encourages the patient’s
empowerment which consequently very often results in better compliance with
treatment.
There are instances where the new act allows
withholding of certain rights – such as freedom of communication and free
access to one’s records. Such instances need to be sanctioned in writing by the
Commissioner for the Promotion of Rights of Persons with Mental Disorders, a
new office established by the new act whose main role is the advocacy and
safeguarding patients’ rights. The law contemplates only two instances where
such sanction is permissible, namely when communication to third parties is a
nuisance to the recipient and when access to all information held in our
records is detrimental to the patient’s well being.
Another source whereby such client group are
often abused and their rights violated are from their relatives or curators. I
do not need to give graphic examples of such abuse as I am sure that you are
cognisant of such instances. The new act
addresses such abuse. First of all it
gives the right to the patient to appoint a responsible carer to act on his
behalf – who is not necessary, the next of kin. This position has been enacted
to reflect current social changes. It is also aimed to ascertain the patient’s
choice and to do away with the legal responsibilities of the next of kin who
may have vested interests not to act in the best interest of the patient.
When curators are appointed by the competent
court, the new act is more stringent on the duties and responsibilities of such
curators to ensure that patients are not abused nor have their fundamental
human rights violated. Curators will now have to seek permission from the
commissioner before disposing the assets of the patient to the third
parties. Curators must also submit an
income expenditure account with all relevant documents to the Commissioner so
to ensure that patients are not deprived from their rightful wealth.
The new act also gives a voice to the children.
We often hear about the need to seek children’s views prior to any decision
that may affect their welfare. The new Mental Health Act stipulates that in
instances where the child is a patient and possesses enough maturity to decide
on his own welfare, the health care professionals are duty bound to seek the
child’s consent for the treatment plan. This provision aims to minimise the
abuse and violation some children suffer in unfortunate instances, where they
are used as pawns in dysfunctional families.
In this conference, you are discussing restrain
and seclusion. Whilst such modalities of treatment are necessary in the mental
health care sector, I encourage you to explore new techniques to practice more
humane treatment, such as chemical against physical restraint. I am confident
that restrain and seclusion are used for the patient’s or third party
wellbeing, but it is also true that sometimes such systems can be abused. The
new act is very explicit with regards to seclusion. It can only be ordered by a
clearly authorised doctor. The doctor is obliged to register in the medical
file and on a special register the reason for such seclusion and its duration.
During seclusion the patient must remain under close supervision of a qualified
health professional. The act makes it an offence to peruse seclusion as a
punishment.
On a parting note, I encourage you to find a
modus operandi to effectively address violence and aggression not solely from
the health professional point of view but also from the patient’s
perspective. These practices should be
embedded in written management protocols.
Thank
you again for organising this conference and for the opportunity to discuss such
an important theme. Your presence here
today is a proof of your
never failing comitment to continue to deliver the best care possible. We are
indeed privilleged to have you on board.
I
wish you all a successful conference.
