Uploaded by Jennifer Basilio

4 Patient Rights

Behavioral Health: Patient Rights
Behavioral Health: Patient Rights
Welcome to the Behavioral Health Services course on Patient Rights.
Behavioral Health: Patient Rights
This CE activity is intended for an interprofessional healthcare audience. It is designed to assist the
nurse and social worker with improving the patient’s perception of being informed of their rights and
care decisions.
Behavioral Health: Patient Rights
By the end of this course you will be able to:
describe how to apply patient rights for the patient with behavioral health needs
identify the principles and strategies for managing patient and family complaints
demonstrate knowledge regarding patient confidentiality and when information may be
released without consent, and
recognize and understand how to report abuse, neglect and exploitation.
Behavioral Health: Patient Rights
We never know what emotional burdens our patients are carrying when they walk through our doors.
Let’s view a case study of a 28 year old male who entered your Emergency Department with a mental
health crisis. He has no family present. The EMS Team brought him to your Emergency Department,
after a concern from a restaurant manager that this patient was “acting bizarrely and frightening
customers in the restaurant.”
Click Play to see how the scenario might play out. (video plays)
Behavioral Health: Patient Rights
Many of our patients with behavioral health needs to come to the hospital from the Emergency
Department, when the person is experiencing a mental health crisis. How can we manage the crisis
and still provide the patient rights with dignity and respect? How could the Emergency Department
Team provide care without jeopardizing safety?
Let’s revisit the scenario to see how the staff takes a different approach. (video plays)
Behavioral Health: Patient Rights
When a patient enters the hospital for care and treatment, they have basic rights as a patient.
Upon admittance to the hospital an explanation of Patient Rights must be available to all patients.
Additionally, hospital staff must ensure that the patient has information provided to them in a way that
they can understand.
Care, treatment, and services must be provided in the least restrictive environment in accordance
with laws and regulations.
Next, an individualized care plan is developed in collaboration with the patient and, when appropriate,
the family or guardian.
A qualified professional is responsible for overseeing the implementation of the patient’s treatment
A patient is permitted to perform services on the Unit only if it is included in the Treatment plan and is
All such services must comply with federal, state, and local laws and regulations.
Can you think of a services example for a patient with dementia? Engaging in a familiar activity such
as folding laundry can be very therapeutic and calming for a patient with dementia.
Behavioral Health: Patient Rights
Now let’s discuss universal patient rights in detail.
Patients must be free from mental, physical, sexual and verbal abuse, neglect and/or exploitation.
Patients must be free from threats of seclusion or restraint.
Patients have the right to treatment in a facility that is clean and well-maintained.
Patients have the right to age appropriate treatment on a unit that is appropriate for their
developmental stage.
Patients have the right to receive proper meals to meet nutritional needs.
Patients have the right to Access to services regardless of age, race, religion, or disability.
Behavioral Health: Patient Rights
When a patient is admitted to a psychiatric unit, they maintain their rights as a citizen. These include:
The right to use or keep money as he or she chooses. While it is usually recommended that a
patient allow for his or her money to be locked in a safe, if the patient chooses to keep the
money in his or her possession, they must be allowed to do so. Proper documentation of this
will decrease problems if the money is lost.
The right to vote. If an election is being held (regardless of whether it is at a city, state or
national level) the patient should be allowed to vote and accommodations must be made to
ensure this right is upheld.
The right to possess and use their personal property. This right allows patients dress in their
own personal clothing and use their own toiletries if they choose to do so. Often, toiletries or
other belongings that may present a safety hazard, are held behind locked doors and provided
to the patient for use during daily grooming time.
The right to private, unimpeded and uncensored communication with persons of his/her
choice. Communication includes mail, phone, or visits. Visits are expected to occur at
reasonable times and places. Any restriction in communication is in accordance with state law.
Patients have the right to practice religious beliefs and to be visited by a spiritual advisor of
their choice at any time.
The patient has the right to access protective and advocacy services.
In programs that provide opportunities for work, a defined policy addresses the situation in
which patients work.
Patient rights may be reasonably restricted by the attending physician in accordance with state
law to protect the patient or others from harm, harassment and intimidation, as long as notice
of such restriction is given to all patients upon admission or upon the decision to restrict
Behavioral Health: Patient Rights
Patients have the right to give informed consent for all treatments, services and medications, unless
such services are necessary to prevent the patient from serious harm to self or others.
Informed consent includes communication by the provider regarding the risks and benefits of the
proposed treatment and the reasons for the proposed treatment.
The patient is permitted to have the nature of all prescribed medications explained, the reason for the
prescription and the most common side effects.
Remember that patients are permitted to refuse certain services but in these cases the attending
psychiatrist must also inform the patient and/or guardian of the risks of refusal.
Finally, the patient shall not be subject to such procedures as psychosurgery, electroshock therapy,
experimental medication, aversion therapy or hazardous treatment procedures without the written
consent of the patient or guardian.
Behavioral Health: Patient Rights
When the patient’s right to communication is resulting in harm, harassment or intimidation to the
patient or others the interdisciplinary team evaluates the clinical effectiveness of specified restrictions
to the right to communication as a therapeutic intervention.
Document the evaluation in the medical record. Explain the clinical reasons and specific plans for
restricting the patient’s communication to the patient and/or family.
When restricting a patient’s rights, there must be a clear explanation to the patient and/or family
regarding the reason for this restriction. You must start by ensuring that the Patient Rights were fully
explained to the patient and/or family as part of their admission.
Behavioral Health: Patient Rights
Possession of certain types of property may be restricted by the Medical Director, Program Director,
or Clinical Manager to protect the patient or others from harm, provided notice is given to all patients
upon admission. When a patient is discharged from the hospital, all lawful property is returned.
Behavioral Health: Patient Rights
The following should be addressed to ensure that the process for restricting patient rights is based on
therapeutic needs of the patient, and is not easily abused.
First, obtain the physician’s order specifying the modality and duration of the restriction.
Next, amend the treatment plan to include the restriction.
Evaluate and document the therapeutic effectiveness of rights restriction daily.
Restore full rights immediately upon cessation of therapeutic need to protect the patient or others
from harm, harassment or intimidation.
Behavioral Health: Patient Rights
Patients have the right to voice opinions, recommendations and grievances related to policies and
services offered on the Unit.
Patients or family members may file complaints about any aspect of care.
Phone numbers and directions for making a complaint must be posted on unit.
Posted phone numbers should include:
Local and state agencies or advocates
Medicare and Medicaid Program Certification and Resident Assessment, and
The Joint Commission.
When managing complaints, follow your hospital grievance policy.
Behavioral Health: Patient Rights
Behavioral Health: Patient Rights
Patients have the right to confidentiality while receiving Behavioral Health treatment.
Patients may sign a release of information form delineating those persons that can be involved in
their treatment and have discussions with the BH staff providing the treatment.
Information must be released in a manner consistent with federal and state laws. Privacy and
confidentiality are the privileges of the patient, so only he or she may waive them, in a non-coerced
Conflict between patient’s right to privacy and a third party’s need to know should be resolved in favor
of patient privacy and confidentiality, except where that may result in serious harm to the patient or
Behavioral Health: Patient Rights
Behavioral Health staff should never inadvertently inform a caller of a patient’s presence on the unit.
During the admission process, the patient should be provided with a code number of their choice to
share with contacts who may call them. If a caller does not have a code number, the staff member
should state that they cannot confirm or deny if the patient is on the unit due to confidentiality laws.
Check with your supervisor to understand the specific process used at your facility.
Information may be released to friends and family who have the patient’s code number.
HIPAA is balanced to protect an individual’s privacy while allowing important law enforcement
functions to continue. Information may be disclosed to comply with a court order, in response to a
written administrative subpoena, for the purposes of identify or locating a suspect, fugitive, material
witness or missing person. However information must be limited to only the scope of information
needed by the request. Please see the Health and Human Services website for further details of
privacy rules and approved releases to law enforcement.
Other healthcare providers are considered covered entities and may receive information in
accordance with continuity of care. Health Insurance companies are also covered entities and HIPAA
allows the release of information for the purposes of payment.
Reports of abuse are allowed to appropriate human services departments.
Behavioral Health: Patient Rights
Due to the rise in social media activity by hospital staff, it is important to take the following guidelines
into account if they use social media. Employees are reminded that they should have no expectation
of privacy while posting information to social networking sites. Postings often can be reviewed by
anyone, including HCA Healthcare representatives and/or its affiliates.
HCA Healthcare and its affiliates respect the right of employees to participate in blogs and use social
networking sites during non-working hours and does not discourage self-publishing or selfexpression.
Employees are expected to follow these guidelines and policies to provide a clear distinction between
you as an individual and you as an employee:
You are personally responsible for your commentary on social media. You can be held personally
liable for commentary that is considered defamatory, obscene, proprietary or libelous by any offended
party, not just our organization.
Employees should not use blogs or social networking sites to harass, threaten, discriminate or
defame employees or anyone associated with or doing business with the organization or its affiliates.
When you identify yourself as an employee of HCA Healthcare or an affiliate, some readers may view
you as a spokesperson. Because of this possibility, you must state that the views expressed by you
through social media are your own and not those of the organization, nor of any organization affiliated
or doing business with HCA Healthcare and/or an affiliate.
Behavioral Health: Patient Rights
Never post company-privileged or confidential information, including copyrighted information,
company-issued documents, or most importantly patient protected health information.
Regarding workplace photographs: Photos showing patients or family members, or showing protected
health information, may not be posted at any time. Be mindful of public perception and use good taste
if you decide to post a workplace photo, and always ask permission before posting photos of coworkers. Take care that any appropriate work place photographs do not accidentally contain patients
or their family, or protected health information in the background.
Never use your personal social media account to discuss or communicate patient information with a
patient, even if the patient initiated the contact or communication. Always use Company-approved
communication methods when communicating with patients about their health or treatment.
Consult the Information Security site on Atlas for social media information security tips.
If you have any questions relating to these guidelines, ask your supervisor, another member of
management, your HR Director, Marketing Director, ECO or FISO.
Behavioral Health: Patient Rights
Given patient consent, participation of the patient’s family, legal guardian or significant other is
There are many steps in the treatment process that can include family participation. On Admission,
the family, is encouraged to participate in the development of the treatment plan, and to acknowledge
understanding of the treatment objectives. Family may be given copies of the treatment plan after
appropriate releases have been signed.
Family may also participate in the treatment review processes.
Family participation, and agreement with the plan of treatment should be documented by the nurse or
case manager in the patient’s medical record.
What action should the nurse take if the patient is unable to sign or refuses to sign the treatment
plan? The nurse will document an explanation in the Electronic Health Record and provide the
patient with a copy of the treatment plan
Behavioral Health: Patient Rights
The patient has a right to inspect and obtain a copy his/her medical record. The release of privileged
medical information and/or the review of a medical record requires written authorization of the patient
or an authorized agent. This authorization must be given freely and without coercion.
It is permissible to withhold all or part of the patient’s medical record under the following
Withholding is necessary to protect the confidentiality of other sources of information.
Information requested is detrimental to the physical or mental health of the patient or may
cause the patient to harm self or others.
Granting the request could cause harm to the patient/program relationship or the program's
ability to provide services in general.
Behavioral Health: Patient Rights
When patient requests to review their record, there is a process that must be followed to ensure that
information is released appropriately.
First, the patient makes the request in writing.
Next, a physician reviews the request and writes an order for patient to review records. If any
information should be excluded from the review it is indicated during this step, along with a rationale
for the exclusions.
Third a licensed staff member sits with patient to review record.
Requests for a copy of the record are facilitated through HIM, usually after discharge, and there may
be a charge incurred to the patient.
Behavioral Health: Patient Rights
Duty to Warn is the obligation to report threats made to a person to warn them of such threats. Not all
states have a Duty to Warn law, so it is important that you follow your hospital policy on reporting
threats to possible victims. If any Unit staff has reason to believe that an individual has the intent and
ability to carry out an explicit threat of inflicting imminent and serious physical harm or causing the
death of an identified potential victim, the following actions must be undertaken in a timely manner:
Notify the program director, medical director and the administrator on call immediately.
Contact the hospital Risk Manager and/or hospital legal counsel for consultation as indicated.
Use whatever means necessary to admit or keep the patient hospitalized, even if this involves an
involuntary admission.
Establish and implement a written treatment plan that attempts to eliminate the possibility the patient
will carry out the threat.
The staff must then initiate plans for a second opinion risk assessment prior to the patient’s
Communicate with a law enforcement agency having jurisdiction where each potential victim resides.
If feasible, communicate to each potential victim or to the potential victim’s parent or guardian.
When communicating to any of the above mentioned, all of the following information must be given:
The nature of the threat. The identity of the patient making the threat. The identity of each potential
Behavioral Health: Patient Rights
In a Duty to Warn situation, consider each of the actions and document the reason for choosing or
rejecting each action.
Consider the actions that would cause the least violation of the patient’s rights without impinging on
public safety.
Do not select an action that would physically endanger any staff member, increase the danger to a
potential victim, or increase danger to the patient.
Staff are not liable for disclosing confidential information for the purpose of predicting, warning or
taking precautions to prevent violent behavior.
Behavioral Health: Patient Rights
Abuse may be categorized as physical, emotional, psychological or financial and may include
Behavioral Health: Patient Rights
Patients have the right to treatment free from abuse, neglect and/or exploitation.
Additionally, the law requires the reporting of any abuse, neglect or exploitation of a vulnerable
Vulnerable persons include the elderly, dependent adult and children.
Next we will discuss each of these forms of abuse in detail.
Behavioral Health: Patient Rights
Physical abuse includes: Assault, battery, assault with a deadly weapon or force which is likely to
produce great bodily injury.
It also includes unreasonable physical constraint or prolonged or continual deprivation of food or
water; use of physical or chemical restraint or psychotropic medication under any of the following
conditions is considered physical abuse: for punishment, for a period significantly beyond that which
the restraint or medication is authorized for any purpose not consistent with that authorized by the
Behavioral Health: Patient Rights
There are many physical signs that indicate physical abuse. Keep these in mind during patient
checkups and don’t be afraid to raise a red flag if you are concerned.
Behavioral Health: Patient Rights
Additionally there are behavioral indicators that a patient may be the victim of physical abuse. These
Conflicting histories of injury or bizarre or inappropriate explanation of injuries.
Patients having long delays between sustaining an injury and seeking treatment.
Patients claiming to have a history of being “accident prone.”
Patients arriving with separately untreated old injuries.
Patients with multiple injuries in various stages of healing, and
Patients returning for treatment for repeated injuries of the same nature.
Behavioral Health: Patient Rights
Sexual abuse includes sexual assault or sexual battery, such as rape, incest, sodomy, oral
copulation, and penetration of a genital or oral opening by a foreign object.
Behavioral Health: Patient Rights
Emotional Abuse is an attempt to control others through the use of emotional manipulation.
These emotional manipulation tactics can include:
constant criticism and/or blame
verbal shaming
belittling and/or name calling
withholding affection as punishment
threats of punishment,
“mind games” such as gaslighting, and
isolating the victim from others.
Behavioral Health: Patient Rights
Indicators that a patient may be a victim of emotional abuse include:
An observable change in effect of patient when significant other or family member is present.
You may also notice behavioral red flags from the patient’s family member or significant other. This
frequently yelling or name-calling when conversing with the patient, or humiliating and insulting
the patient
blaming the patient for their condition or problems
and threatening the patient or staff with violence and/or retaliation.
Behavioral Health: Patient Rights
Financial Abuse is described as a situation in which any person who has the care of custody, or who
stands in a position of trust to an elder or dependent adult takes, secretes, or appropriates his or her
money or property to any use or purpose not in the due and lawful execution of his or her trust.
Financial abuse is also applicable when a third party who holds or controls the property of the
dependent or elder adult refuses to comply with his/her requests for use or transfer.
Behavioral Health: Patient Rights
Neglect is generally described as the failure by another individual to provide a person with the
necessities of life. More broadly, neglect is the negligent failure of any person having the care or
custody of an elder or dependent adult to exercise the degree of care which a reasonable person in a
like position would exercise.
Negligent failure includes, but is not limited to:
failure in the provision of food, clothing, or shelter
failure to assist in personal hygiene
failure to prevent malnutrition
failure to protect from health and safety hazards
or failure to provide medical care for physical and mental health needs
Unless the elder or dependent adult voluntarily relies on treatment by spiritual means, through prayer
alone, in lieu of medical treatment.
Behavioral Health: Patient Rights
Let’s take a look at three more forms of abuse.
“Abandonment” is described as desertion or willful forsaking of an elder or dependent adult who is
unable to care or provide for self by anyone having care or custody of that person under
circumstances in which a reasonable person would continue to provide care and custody.
“Isolation” is described as preventing the elder or dependent adult from receiving mail, telephone calls
or visitors, contrary to that person’s wishes, except when done under physician’s instructions as part
of a plan of treatment or in response to a reasonably perceived threat of danger to property or
physical safety.
“Exploitation” is the unfair use or abuse of a person for personal gains, usually financial in nature.
Behavioral Health: Patient Rights
When abuse or neglect is alleged or suspected, the manager, attending physician, and other
treatment team members involved in the patients care should be notified immediately to determine
the plan for addressing immediate patient needs and ongoing safety.
The hospital and state policies should be consulted for the process and time frames for reporting.
Behavioral Health: Patient Rights
There is a myth that only social workers can report evidence or suspicion of abuse. This is incorrect.
Any person who has information or evidence that abuse exists or reasonably believes that abuse or
neglect exists, is responsible for reporting the abuse to the appropriate state agency.
It is okay to make a report if you reasonably believe abuse or neglect may be occurring, even if you
are not 100% sure. Persons voluntarily reporting in good faith are immune from civil or criminal
Behavioral Health: Patient Rights
Let’s move on to another case study. Meet our patient Mary. Based on your assessment and this
interview, what do you anticipate that Mary may need as part of Mary’s discharge plan?
(video plays: Mary is unsure of the date, the town she’s in, and she’s not sure she’s in a hospital; she
says she doesn’t feel so good)
Behavioral Health: Patient Rights
Based on the initial assessment, Mary may need home custodial care. It could be considered Elder
Neglect if Mary is sent home to live independently.
Behavioral Health: Patient Rights
Now it’s time for a knowledge check. The following section includes a sample of questions that often
arise on a Behavioral Health unit.
Behavioral Health: Patient Rights
How would you respond? Is this a patient right?
Involuntary patients still have the right to refuse medication, groups and other treatment. Medications
may be forced only in an emergency or if there is a judicial order that specifically addresses
Behavioral Health: Patient Rights
What would you say in this case?
Most hospitals have no smoking campuses and have the right to limit smoking in their place of
business. Thus, patients do not have the right to smoke on the unit.
Behavioral Health: Patient Rights
Is this a patient right?
Patients have the right to make and receive phone calls but the hospital has the right to identify
reasonable times for this to occur. Patients may use the phone outside these times as coordinated
with the treatment team, and documented in his/her treatment plan. If phone calls at 2am are deemed
harassment, or are causing harm, then patient rights may be restricted with a physician’s order.
Behavioral Health: Patient Rights
What about in this example?
Patients do have to right to request discharge even against medical advice; however, if the
psychiatrist feels that the patient is a danger to self or others, an involuntary hold may be place in
accordance with state laws.
Behavioral Health: Patient Rights
Does the patient have the right to keep all of their possessions?
Patients do have the right to keep their possessions; however, items that are considered a safety
hazard to the patient or others on the unit may be secured with only supervised access while in the
hospital. Jewelry is an example of a potential safety hazard.
Behavioral Health: Patient Rights
Is this a patient right?
Watching television is not considered a personal right. Patients must follow the rules set by the
Behavioral Health Unit to ensure that the environment is conducive to treatment for everyone on the
Behavioral Health: Patient Rights
By now you should be able to describe how to apply patient rights for the patient with behavioral
health needs identify the principles and strategies for managing patient and family complaints
demonstrate knowledge regarding patient confidentiality and when information may be released
without consent and recognize and understand how to report abuse, neglect and exploitation.
Behavioral Health: Patient Rights
The following were used as references for the information presented in this module.
Behavioral Health: Patient Rights