Consent

Patients have a fundamental legal and ethical right to determine what happens to their own bodies. Valid consent to treatment is therefore absolutely central in all forms of healthcare, from providing personal care to undertaking major surgery. Seeking consent is also a matter of common courtesy between health professionals and patients.

Information and Choice: Making Rights & Expectations Explicit

All treatments have the potential to do harm as well as good and so workers need safe guard the principle of informed consent .Service users should have access to the same information that is available to workers (research reports, for example), and should have the right to refuse treatments, including medication, ECT and psychological interventions .

The British Psychological Society's Division of Clinical Psychology recommends that each service should publish an explicit statement of what users can expect. One possible example would be the following. Not everything on this list would be possible in every service especially in settings such as wards where some service users are being detained against their will, and it would need to be adapted for local circumstances.

• As a client you have the right to:
• Receive respectful treatment;
• Refuse treatment or a particular intervention strategy;
• Ask questions at any time;
• Know your worker's availability and waiting period;
• Have full information about your worker's qualifications including registration, training and experience;
• Have full information about your worker's areas of specialisation and limitations;
• Have full information about your worker's therapeutic orientation and any technique that is routinely used;
• Have full information about your diagnosis, if used;
• Consult as many workers as you choose until you find one you are happy with;
• Experience a safe setting free from physical, sexual or emotional abuse;
• Agree to a written contract of treatment/care;
• Talk about your treatment with anyone you choose, including another worker;
• Choose your own lifestyle and have that choice respected by your worker/s;
• Ask questions about your workers' values, background and attitudes that are relevant to therapy and to be given respectful answers;
• Request that your worker/s evaluate the progress of therapy/treatment;
• Have full information about the limits of confidentiality;
• Have full information about the extent of written or taped records of your therapy/treatment and your right of access;
• Terminate therapy/treatment at any time;
• Disclose only that personal information that you choose;
• Require a written report on therapy/treatment;
• Have access to any written summaries about your therapy/treatment.

Information and choice: The issue of coercion and mental health legislation

The issue of information and choice is particularly important because of the legal context within which mental health services operate. In the past, mental health services have often adopted a paternalistic approach, and in the context of limited resources extensive use has been made of the powers of coercion available under mental health legislation. This has led to a situation where many people have experienced mental health services as coercive and restrictive, and has often been a barrier to the establishment of the trusting, collaborative working relationships which are the cornerstone of an effective service.

A psychological approach to psychotic experiences such as that described in this report necessitates a willingness to discuss psychotic experiences openly and frankly. It is unfortunate that historically this has often led to unpleasant consequences for people such as involuntary hospitalisation and forced medication. Any extension of powers of compulsion would be likely to continue this trend and thereby make it even harder for services to engage collaboratively and openly with people who have psychotic experiences. Many psychologists feel that the very existence of separate legislation that only applies to people deemed 'mentally ill' is discriminatory, especially given the difficulties in defining 'mental illness' referred to above.

An alternative would be more general legislation based on someone's ability to make decisions ('capacity') rather than on whether he or she has a psychiatric diagnosis complacency on this topic, the limitations of techniques for risk assessment also need to be acknowledged. It has been suggested that 'risk factors are somewhat like weather prediction: better at providing an overall picture than a guarantee that we can be sure of what will happen in any specific situation'. In light of this 'perhaps our most appropriate approach should be to refine and evaluate our basic clinical skills. Suicide rates might well then look after themselves'. [3]