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Improving Mental Health

BENCHMARKING TOOL

A HUMAN RIGHTS BASED APPROACH

Authors

Debbie Bannister

Laura Nicholson

Emma Ward

Amy Lee

Kulvinder Kaur

Richard Whitehead

Dr. Alex Cookson

Dr. Beth Greenhill

Also available:-

1) Keeping Me Safe and Well Risk Assessment

2) Human Rights Joint Risk Assessment and Management Plan

3) Speaking Up for Myself Group

4) Standing Up for My Rights Booklet

5) Accessible Information Pack

This manual is a Mersey Care NHS Trust publication and should not be reproduced without the authors’ permission. The manual

can however be printed and used clinically as part of a validation process. If you wish to take part in our validation project please

contact the authors below. The validation process will contribute to any further revisions to the document.

For further information and training opportunities contact:-

[email protected]

[email protected]

© <2008> Mersey Care NHS Trust. All rights reserved. This material may be copied for

use within NHS organisations only on the understanding that Mersey Care NHS Trust is

acknowledged as the developer of the material on all copies and that this copyright statement

is retained.

Contents

Introduction to Human Rights 3

Use of this tool 4

1. Human Rights Joint Risk Assessment and Management Plan (HR-JRAMP) documentation 4

2. Physical Intervention 6

3. Staffing 7

4. Health Action Plan and other health issues 8

5. Involvement 10

6. Essential lifestyle plan and daily living 12

7. Activities and employment 15

8. Housing (A) 17

9. Housing (B) 20

Introduction to Human Rights

The Human Rights Act was introduced into UK law in 1998, coming into force in 2000. It provides the legal framework by which

rights can be implemented. The Act means that all public authorities (including NHS Trusts and Social Services), have an obligation

to ensure that people’s rights are respected in all that they do. Public authorities also have a positive obligation to ensure that

people’s rights are not breached. Anyone who is a ‘victim’ under the Human Rights Act can claim a breach of their rights against a

public authority in UK courts, and through tribunals, hearings and complaints procedures.

Aside from legal obligations, the Human Rights Act provides public authorities with a base from which rights can be made real.

Taking proactive steps to promote human rights can improve the provision of services and ensure that service users are able to

enjoy their rights in a meaningful way.

Human rights are underpinned by a set of core values known as the ‘FREDA’ principles. These are:

Fairness

Respect

Equality

Dignity

Autonomy

These principles find their expression in a range of human rights laws. Human rights laws act as a vehicle for making these core

values real in people’s lives.

The rights are:

Article 2 – The right to life

Article 3 – The right not to be tortured or treated in an inhuman or degrading way

Article 4 – The right to be free from slavery or forced labour

Article 5 – The right to liberty

Article 6 – The right to a fair trial

Article 7 – The right to no punishment without law

Article 8 – The right to respect for private and family life, home and correspondence

Article 9 – The right to freedom of thought, conscience and religion

Article 10 – The right to freedom of expression

Article 11 – The right to freedom of assembly and association

Article 12 – The right to marry and found a family

Article 13 – N/A

Article 14 – The right not to be discriminated against in relation to any of the Right contained in the European Convention

Article 1 Protocol 1 – Right to peaceful enjoyment of possessions

Article 2 Protocol 1 – Right to education

Article 3 Protocol 1 – Right to free elections

In essence, employing a Human Rights Based Approach (HRBA) promotes a shared sense of entitlement, encourages personal

responsibility and upholds respect for the rights of others; whilst accounting for issues of equality and diversity.

If you are interested in learning more about Human Rights and how they are applied to healthcare, please refer to ‘Human Rights in

Healthcare – A Framework for Local Action’ (DOH, 2008).

Use of this tool

This tool assesses how human rights are being incorporated into the lives of people supported by ‘complex care pathways’. It

evaluates the extent to which a human rights based approach is taken by the services they use; whether these services are being

provided by health, local authorities, or private and voluntary sector organisations.

The tool should be completed on an annual basis, with the exception of Section 8 (Housing, Part B). This section should be

completed only when the service user is due to move accommodation, in order to assess the suitability of their first choice of

accommodation.

At the initial stage of the pathway, a Care Programme Approach (CPA) coordinator, social worker and manager of the package

should be identified to take responsibility for completing the tool. They should also be responsible for actioning any suggestions that

result from the evaluation, developing a plan, and setting the review date for the following year. These details should also be sent to

the commissioners of the package. Acceptable scores will vary between sections. There are also key questions (highlighted in red)

for which a score of ‘0’ will always require immediate attention, regardless of the overall score for the section.

Normative standards are in the process of being developed, against which complex care packages will be assessed at one, two,

and three years after the service user has returned to their local community. An acceptable level of human rights based thinking and

service user inclusion at year three will be greater than that expected in year one. It is hoped that all services will use the results of

this tool to highlight areas in which they can improve.

Figure 1: Progression of human rights based care

1. Human Rights Joint Risk Assessment and

Management Plan (HR-JRAMP) Documentation

During the completion of the HR-JRAMP, balanced decision making should be used to ensure that management strategies are

assessed in terms of the impact on the human rights of the service user and those directly involved with the service user. The

strategy should be proportionate to the risk. The NHS trust and local authority are accountable to ensure plans and strategies are

assessed in terms of human rights impact.

Service user involvement is essential in the development of risk management plans. This is crucial in maintaining the service user’s

right to respect for a private and family life, home and correspondence (Article 8). The service user should be given as much

independence as possible and be given the maximum choice. They should be supported in judging the potential harm and benefits

of risky behaviour and the intervention. In addition, the FREDA principles are likely to be applicable if service user is not being

treated fairly, or with dignity.

0 No Unacceptable.

1 Yes Service user not involved.

2 Yes The risk screen was individualised to promote

service user involvement.

0 No Human Rights guidelines were not consulted.

1 Yes Guidelines were consulted.

2 Yes Guidelines were consulted and this process was documented.

0 No Unacceptable.

1 Yes Service user not involved in development of plan.

2 Yes Service user involved in development of plan.

0 No Unacceptable.


2 Yes Identified with service user.

0 No Unacceptable.

1 Yes Service user not involved in development.

2 Yes Service user involved in development and the

strategies are integrated into their care plan/CPA documentation.

0 No Staff/service user not consulted.

1 Yes Staff consulted.

2 Yes Service user involved through Essential Lifestyle Plan (ELP)

/Staying Well Plan/Advanced Statement.

0 No No strategy work has been completed with service user.

1 Yes Service user involved in development.

2 Yes Service user involved in development and this is integrated into

their care-plan/CPA documentation.

0 No There is no Advanced Statement


2 Yes Service user involved in development and this is integrated into

their care-plan/CPA documentation.

1 Was the Risk Assessment

completed within 6 weeks

of allocation?

2 Was the risk considered in

terms of relevant human

rights?

4 Have early warning signs of

challenging behaviour/mental

health relapse been identified?

3 If high levels of risk were

identified, has a HR-JRAMP or

Intermediate Risk Assessment

and Management Plan

(I-RAMP) been produced?

5 Are relapse prevention

strategies in place? (e.g. early

warning signs documented)

6 Have proactive and reactive

strategies been developed?

7 Has ‘Staying Well’ or other

coping strategy work been

completed with the service

user?

8 Has the service user made an

Advanced Statement?

Total score for section 6 /16

2. Physical InterventionPhysical intervention should be treated with caution as there is a very real risk of breaching a service user’s human rights.

Particularly relevant articles in terms of restraint include: the right to respect for private and family life (Article 8) and the right not to

be tortured or treated in an inhuman or degrading way (Article 3).

Article 8An important aspect of Article 8 is psychological and physical integrity. Restraint has the potential to breach article 8 if the service

user’s human rights are not considered. It must be ensured that any action of restraint is balanced and proportionate to the risk. The

least restrictive option must be used at all times and should be in accordance with the FREDA principles (i.e. the service user

should be treated with fairness, respect and dignity in the case of restraint). In regard to the items outlined below, article 8 could be

breached easily if for example the service user is not asked about their preference regarding physical intervention.

Article 3If restraint was very severe and used with excessive force (i.e. not proportionate to the risk), it could potentially be considered

inhuman or degrading treatment. If this is suspected, action should cease immediately because article 3 is an absolute right that

should not be compromised.

0 No Unacceptable.

1 Yes But not reassessed at appropriate intervals.

2 Yes Physical assessment carried out every 6 months.

0 No Unacceptable.

1 Yes But these were not recorded.

2 Yes Service user’s preferences are recorded and discussed as part

of the multidisciplinary team (MDT) but the intervention is

proportionate to the risk.

0 No Unacceptable.

1 Yes Physical intervention is only used as a last resort.

2 Yes Physical intervention is only used as a last resort and is always

the least restrictive and proportionate intervention. The service

user’s preferences are taken into account.

0 No None received – unacceptable.

1 Yes Staff receive appropriate Managing Violence and Aggression

(MVA) training.

2 Yes Staff receive appropriate Managing Violence and Aggression

(MVA) training with frequent refreshers.

0 No No de-briefing takes place.

1 Yes But there is no set protocol for this.

2 Yes There is a set protocol for this.

0 No No de-briefing takes place.

1 Yes But there is no set protocol for this.

2 Yes There is a set protocol for this.

1 Has a physical

assessment of the person

been carried out prior to

using physical intervention

strategies?

2 Has the service user been

asked about their

preferences regarding

physical intervention (e.g.

type, by whom)?

4 Are staff adequately trained in

the use of physical

intervention?

3 Is physical intervention always

used in the appropriate

context?

5 Is the service user de-briefed

after the use of physical

interventions?

6 Are the staff involved de-briefed

after the use of physical

interventions?

7 Other areas of concern / good practice (please give details below).


3. Staffing

Service users should have as much autonomy as possible (e.g. being involved in choosing their staff team) and feel as though they

are treated with fairness and respect. For example, staff should be able to communicate effectively with the service user.

Staff need to be aware of what their responsibilities are in terms of the Human Rights Act. Empowerment is a key principle and

increasing staff awareness of human rights empowers staff and thus has a direct positive effect on the service user. Accountability

is also an important aspect of the human rights based approach. Staff are accountable for their work and need access to

appropriate supervision for support and advice. Having a procedure in place for service users to complain about actions of a staff

member is one way of ensuring accountability. Staff’s human rights will normally be respected by the balancing procedures outlines

in the HR-JRAMP.

Article 8When considering the staff team, the right to respect for private and family life is particularly important (Article 8). If the team are

based in the service user’s home they will have a significant impact upon their life. If for example, members of staff cannot

communicate properly with the service user, this may have a negative impact on their psychological integrity. It could also result in

the service user not being treated with respect and dignity.

Article 14Article 14: prohibition of discrimination comes into play for some aspects of staffing (e.g. around communication or any specific

training required). For example, If a staff team are working with a service user with autism but have had no training, it could be seen

as discrimination because staff will not be able work and communicate with them effectively.

0 No No human rights training takes place.

1 Yes Staff have access to written documents about human rights.

2 Yes Staff have received training in human rights.

0 No The service user is not involved.

1 Yes The service user plays a role in choosing their staff team.

2 Yes The service user is fully involved in the interview and selection

process, and receives training to help develop necessary skills.

0 No Unacceptable.

1 Yes There is a system in place through which the service user can

raise issues/concerns about staff members.

2 Yes The complaints procedure is discussed with the service user and

is available in an accessible format.

0 No No regular team meetings take place.

1 Yes Regular team meetings are held.

2 Yes Regular team meetings are held and the service user is invited to

attend for some or all of the meeting.

0 No Only when there is an incident or problem.

1 Yes Staff and MDT meet regularly but without service user

involvement.

2 Yes Staff and MDT meet regularly and the service user is invited to

attend all/part of these meetings.

0 No Unacceptable.

1 Yes Staff are regularly supervised.

2 Yes Supervision is provided by appropriately trained and skilled

senior staff.

1 Are all staff trained in human rights?

2 Is the service user involved in choosing

the staff team?

3 Are procedures in place for the service

user to complain about the actions of a

staff member?

4 Are regular team meetings available

for direct care staff?

5 Do direct care staff have regular contact

with the MDT (i.e. clinicians, project

manager and social services)

6 Are staff given regular supervision?

0 No Unacceptable

1 Yes CRB check complete and relevant mandatory training received

(or due to be received).

2 Yes And all staff have a good understanding of why such training and

checks are necessary.

0 No There is no training around the Mental Capacity Act.

1 Yes Some discussion of the MCA and DOLS included in training

sessions on other topics.

2 Yes Staff have received training focussing on the importance of the

MCA and DOLS.

0 No Staff have received no training in specific clinical areas relevant

to the service users.

1 Yes Staff receive relevant training.

2 Yes Staff receive relevant training and their training needs are

regularly reviewed and discussed in supervision.

0 No There are communication difficulties.

1 Yes Staff are aware of effective communication styles and the

importance of this.

2 Yes Staff are competent and effective communicators with the

person.

0 No No formal training given.

1 Yes Brief training given/covered in other training.

2 Yes Detailed training on alternative forms of communication has been

given.

0 No The process doesn’t encourage staff to learn from the incident.

1 Yes Documentation reminds staff to think how they could have acted

differently.

2 Yes Reflective practice of person-centred and human rights-based

approaches is encouraged in staff training and supervision.

0 No There is no policy – unacceptable.

1 Yes All staff are aware of whistle-blowing policies.

2 Yes All staff are aware of whistle-blowing policies and confident in

using them if the need arises.

7 Have staff been CRB checked and

completed relevant mandatory training

(including safeguarding Adults,

safeguarding children & trust/company

policies).

8 Have staff had training around the

Mental Capacity Act (MCA) and

Deprivation of Liberty Safeguards

(DOLS)?

9 Are staff provided with adequate training

to support the service user? e.g.

Training around:

• Autism

• Challenging behaviour

• Mental health

10Are staff aware of how to communicate

effectively with the service user?

11 Are staff aware of alternative forms of

communication? e.g.

• Non-verbal cues

• Challenging behaviour

• Self injury

• Social withdrawal

12Are staff encouraged to be

reflective when completing

critical incident forms?

13Are all staff aware of whistle-blowing

policies and confident to use them?

14Other areas of concern/good practice (please give details below)

4. Health Action Plan and Other Physical Health Issues.

When developing the Health Action Plan (HAP) and planning how to meet the service user’s health needs it is important to consider

the FREDA values and the Human Rights Act. Not having a HAP, for example, has the potential to impact on a number of rights. In

extreme cases, lack of consideration of health issues could breach the right to life (Article 2). The case studies highlighted in the

‘Death by Indifference’ report (Mencap, 2007) demonstrate how serious this is.

Article 8

Article 8, the right to respect for private life, is particularly relevant to this section as it includes a right to physical and psychological

integrity. If the service user is not supported with dignity, respect and autonomy with regard to personal hygiene for example, this

could impact on their right to respect for private life.

Article 3

Article 3, prohibition of torture and inhuman and degrading treatment, could be breached in extreme cases. For example, if a

service user is not supported with personal hygiene and is left in a wet bed for prolonged periods, or if PRN is given without

consent of the service user when there is no protocol in place.

Article 14

If appropriate procedures are not in place, the right not to be discriminated against (Article 14) could potentially be breached

alongside another right, such as the right to respect for private life. This could occur if the service user is unable to access

appropriate health checks, health advice or intervention because of their learning disability.


0 No Unacceptable.



0 No This is not discussed.

1 Yes Personal hygiene is discussed in a sensitive manner with the

service user by members of staff who understand these issues.

2 Yes Steps are also in place to support self esteem and promote

independence in this area.


1 Yes Discussion only.

2 Yes And information in an appropriate format has been provided for

the service user to keep.


1 Yes The benefits have been informally discussed.

2 Yes These have been informally discussed and information has been

provided in an appropriate format.

0 No Such alternatives have not been considered.

1 Yes Medication is the dominant form of treatment but therapeutic

approaches are regularly attempted.

2 Yes Therapeutic approaches are used as a longer term strategy to

support the service user in managing their challenges.

Medication is used rarely, but appropriately.

0 No Unacceptable

1 Yes and the protocol is followed and regularly reviewed

2 Yes The protocol is followed, reviewed and the service user can

Or N/A access it or not applicable because the service user does not

have PRN medication.

0 No Unacceptable.

1 Yes This has been discussed with the service user.

2 Yes This has been discussed and the information has been provided

Or N/A in an accessible format. Where appropriate, the service user has

control over taking their medication.

0 No Unacceptable.

1 Yes Staff receive relevant training.

2 Yes Staff receive relevant training and their training needs are

regularly reviewed.

1 Has a Health Action Plan been

produced, and updated within the last

12 months?

2 Is the service user supported as

necessary to understand the

importance of personal hygiene and

do staff understand what poor

personal hygiene may mean to the

person e.g. mental health concerns/

abuse?

3 Have sexual health issues and

contraception been discussed with

the service user?

5 Have therapeutic approaches (e.g.

psychological therapy, aromatherapy,

massage) been considered, for use

instead of or in addition to medication

(in particular, PRN medication used to

control behaviour)?

6 Is there a PRN protocol?

7 Is the service user aware of any

medication they take, what it is for,

and any possible side-effects it might

have?

8 Do staff who administer medication

receive training on what different

medication is for, the possible side-

effects, etc?

4 Is the service user aware of thebenefits of a healthy lifestyle? E.g.

• Healthy eating• Regular exercise• Impact of smoking and excessive

drinking

9 Other areas of concern/good practice (please give details below)


5. Involvement and Confidentiality

The service user should be given as much autonomy, choice and independence as possible. The principle of accountability is also

important. In this context accountability involves service users being able to complain about aspects of their care. In order to

promote involvement, complaints procedures should be easy for service users to follow. Additionally, it is best practice to ensure

that complaints procedures adhere to the principles of a fair trial because otherwise the right to a fair trial (Article 6) could

potentially be breached. This is true of both the person making the complaint and the person being complained about.

It is important to empower service users so that they know what their rights are and how to claim them.

Article 8

Article 8, the right to respect for private and family life is especially important in this section as it covers being involved in decisions

about your own life. Service users are better able to be involved in decisions if they have information and correspondence in an

accessible format. If a service user’s citizenship is not encouraged or their documentation is not kept confidential Article 8 could

also be potentially breached.

Article 14

If the service user has not been granted access to documents such as their HR-JRAMP or their Essential Lifestyle Plan because

they have a learning disability, Article 14, the right not be discriminated against, could potentially be breached alongside their right

to respect for their private life.

0 No Not involved in any relevant meetings.

1 Yes Attended or invited to attend some relevant meetings.

2 Yes The service user makes an informed decision about attending

i.e. staff explain the purpose of the meeting and who will be

present etc. Where appropriate, the service user leads the

meetings and sets the agenda.

0 No Not informed about the existence of these groups.

1 Yes Informed briefly about these groups, but showed little interest in

attending

2 Yes The service user has been fully informed about these groups

and their potential benefits, with information provided for them

to keep as well as verbal information. They are supported to

attend a group if they wish to.

0 No They are unaware of their rights.

1 Yes An attempt has been made to explain the issue of the Service

User’s human rights to them.

2 Yes The Service User’s human rights have been discussed with

them, and a staff member has worked through the Human

Rights Act in an appropriate format, with the Service User

keeping this information.

1 Has the service user been involved

in relevant meetings?

2 Has the service user been invited to

a group to learn about their rights?

3 Is the Service User aware of their

human rights?

0 No Unacceptable.

1 Yes If the service user raised an issue with their care plan it would

be discussed.

2 Yes Positive and negative aspects of the package are regularly

discussed with the service user.

0 No Unacceptable.

1 Yes But reviews generally do not lead to changes unless problems

are highlighted.

2 Yes And reviewers are proactive in aiming to identify areas in which

the service user’s independence could be promoted.

0 No Not asked.

1 Yes Asked once.

2 Yes This is regularly reviewed

(e.g. each time a new service is involved).

0 No The person has no access.

1 Yes The service user has a copy of these documents.

2 Yes The service user has a copy in an appropriate format

(e.g. easy read).

0 No Unacceptable.

1 Yes Only staff or the service user are able to access these

documents.

2 Yes The importance of confidentiality is fully understood by both

staff and service users and support is provided to store these

documents in a secure place.

0 No The service user does not have any of these things.

1 Yes The service user has some of these things.

2 Yes The service user has all of these things or there are

demonstrable reasons why they do not, which have been


4 Is there a way for the service user

to complain about or express

disagreement with their care plan?

5 Is the amount of support offered to

the service user reviewed at least

every 12 months? (i.e. to facilitate

increasing independence)

6 Has the service user been asked

whether they wish to receive

letters? (e.g. from health, social

services)

7 Does the service user have access

to the following documents?

• HR-JRAMP (if appropriate)

• Health Action Plan

• Essential lifestyle plan (ELP)

8 Is the confidentiality of the above

documents maintained?

9 Is the service user’s citizenship

encouraged? E.g.

• Passport

• Utility bills in their name

• Bank account in their name

• Registered on the electoral role

10Other areas of concern/good practice (please give details below)


6. Essential Lifestyle Plan and Activities

When developing an Essential Lifestyle Plan (ELP) it is important that the FREDA principles and the Human Rights articles are

considered. The FREDA principles are relevant in all items in this section as generating an ELP involves treating service users with

respect and dignity and ensures they have autonomy in their daily lives and future. Meaningful involvement and participation of

service users in decisions about their lives is a particularly important and including the individual in the development of their ELP is

one way to make sure this occurs.

Article 8If the service user does not have (or is not involved in completing) an ELP, there is a very real possibility that their right to respect of

a private and family life could be breached. Article 8 is applicable to a range of issues that are relevant to service users’ daily lives,

including relationships, independent living, visits, diet, cultural and religious practices etc. It is important that plans are in place and

service users are involved in completing these plans in order to ensure that their choices and wishes are reflected. Furthermore,

staff need to make sure they are respecting service users’ wishes and enabling them to carry them out on a day to day basis.

Article 14Respecting and facilitating a service user’s cultural, religious, sexual, gender and political needs in their ELP is one way to ensure

that article 14: the right to be free from discrimination is not breached alongside the right to respect for private life.

0 No Unacceptable



0 No Not involved in any of these decisions.

1 Yes Involved to some extent in some of these decisions.

2 Yes The service user is fully involved in all decisions affecting their

day-to-day life – they are supported by staff to understand the

issue involved, make their own informed decision, and

understand the eventual outcome.

0 No There is no information provided about this.

1 Yes Service user has been informed verbally of the appropriate

method.

2 Yes Service user has been informed about this verbally and been

provided with information in an appropriate format which they can

keep.

0 No Unacceptable

1 Yes The service user is treated with dignity and respect at all time

2 Yes The service user is treated with dignity and respect at all times;

they are involved in making decision to the maximum of their

ability.

0 No Unacceptable

1 Yes Partly met – for example the service user’s mail is private but the

telephone is in a public place.

2 Yes The service user’s mail and conversations are considered private

and the telephone is in a private place.

0 No There are set times for snacks.

1 Yes The service user is able to have drinks and snacks on request.

2 Yes And they can access these facilities independently.

1 Has an ELP been developed?

2 Is the service user involved in

decisions that affect their

day-to-day life?

3 Is the service user aware of how

they can raise issues with their

support?

4 Is the service user treated with

dignity and respect in terms of their

appearance? (i.e. if clothes are

chosen for them, are they well-

fitting and appropriate, regular

haircuts, shaving, etc)

5 Is the service user treated with

dignity and respect in terms of

day-to-day communication? (e.g.

conversations, privacy of post)

6 Is the service user able to have

drinks and snacks when they

wish?

0 No Set meals are provided

1 Yes The service user can choose from a list of options.

2 Yes The service user is supported to contribute to planning their

weekly menu and can make their own meals/there is an

opportunity to do this if appropriate.

0 No This issue has not been assessed.

1 Yes or No Kitchen access has been assessed but the decision has not

been revisited.

2 Yes or No This issue has been thoroughly assessed and the conclusions

drawn have been acted upon. The appropriateness of kitchen

access for the service user is also re-evaluated at regular

intervals.

0 No This is not considered.

1 Yes There is no system in place for this, but if the service user asks

to do this, it is facilitated.

2 Yes The service user is encouraged and supported to undertake

domestic duties if appropriate.

0 No This is not considered necessary.

1 Yes Staff support the service user with their sexuality and intimate

relationships and to be safe.

2 Yes Staff support the service user with their sexuality and intimate

relationships and to be safe. Staff are responsive, respectful

and aware that their own values might affect the service user.

0 No There are no private areas available/there is a blanket policy

that all visits are supervised.

1 Yes The service user has partial privacy but full privacy has not

been considered.

2 Yes or No The service user can have full privacy during visits.

or

Where necessary, visits are supervised but this is due to

specific risks to the service user or their visitors and this is

regularly reviewed.

0 No The service user has not been asked about this.

1 Yes The service user is supported to attend some religious

meetings/festivals, but this is not always possible.

2 Yes The service user has been asked about their spiritual needs

and their preferences are acted upon at all times (if

appropriate)

0 No This is not considered.

1 No The service user has been asked about their needs and their

preferences.

2 Yes The service user has been asked about their needs and their

preferences are acted upon at all times.


choosing their meals?

8 Does the service user have

access to a kitchen?

9 Can the service user undertake

household tasks if they wish? (in

order to increase their

independence and skills in daily

living)?

10Is the service user offered advice

and support with sexuality,

relationship and intimacy issues?


privacy during visits if

appropriate?

12 Is the service user supported to

attend religious meetings /

celebrate religious festivals if

appropriate?

13 If desired, is the service user

able to access services specific

to their individual needs? (e.g.

cultural groups, gender specific

groups)

0 No This has not been considered. Unacceptable.

1 Yes or No The service user has access to their money or their access is

legally restricted. These decisions are not regularly reviewed.

2 Yes or No Staff actively support the service user to develop increasing

financial independence (e.g. the service user has their own

bank account).

Or

Staff restrict the service user’s access to their money for well

documented risk reasons/the service user has an appropriate

appointee. There are regular reviews of these decisions.

0 No This is a blanket policy about specific items.

1 No Access to some items is restricted for well documented risk

reason. This is not regularly reviewed.

2 Yes The service user has free access to their belongings unless

there is a current risk, this is regularly reviewed and all

decisions are well documented.

14 Is the service user supported to

manage her/ his own money?


free access to his/her own

belongings?


7. Activities and Employments

It is important that service users are able to participate in the life of the community through accessing education, community groups

and activities. As well as having a direct impact on human rights, this also prompts consideration of the FREDA principles. The

service user should have as much choice, independence and autonomy as possible in regard to their chosen social

activities/employment. They should also be treated fairly. If the service user does work for example, they should not be exploited

and should be paid an appropriate wage. Ensuring that service users are given a choice in activities is important to enable

autonomy and empowerment.

Article 8Article 8, the right to respect for private and family life, is particularly relevant as it includes respect for meaningful participation in

the community, learning new skills and having access to a range of activities – and being able to make choices about employment

and activities.

Article 14If the service user is denied the opportunity to participate in the community or gain suitable employment for the fact that they have a

learning disability, Article 14, the right not to be discriminated against will be compromised alongside the right to respect for private

life.


0 No No opportunities are available.

1 Yes The service user is taught new skills as the need arises.

2 Yes The service user is actively involved in discussions about what

new skills would be beneficial.

0 No No opportunities are available.

1 Yes The service user has the opportunity to access education.

2 Yes The service user is supported to access education if they wish

to (this is regularly discussed). The education is meaningful

and beneficial to the service user.

0 No Unacceptable

1 No Staff have considered these opportunities, but decided that it

was inappropriate for the service user.

2 Yes the service user is involved in one or more of these activities or

the service user is not involved in these activities, but they

have been discussed, and the service user has decided that

they do not wish to take part.

4 Is the service user currently

learning new skills or

competencies?


access to appropriate

educational opportunities?


the community? E.g.

• Do they have a job in the

community?

• Are they involved in education

in the community?

• Do they undertake voluntary

work in the community?

• Do they attend community

groups?


0 No They have no choice in the activities available.

1 Yes The service user is able to choose which activities to partake in

from those on offer.

2 Yes The service user is supported to access activities other than

those typically on offer (should they wish to) and attempts are

made to engage the service user in new things.

0 No Not discussed.

1 Yes Employment opportunities have been explored briefly.

2 Yes The service user has been supported by staff to fully explore

the possibility of employment.

0 No No pay received.

1 Yes Tokenistic pay received.

2 Yes Full pay received or N/A.

1 Is the service user given a

choice of activities?

2 Have employment opportunities

been explored with the service

user?

3 Are they given adequate pay for

any employment undertaken?


8. Housing (A) (To be completed annually with sections 1-6.)

The Human Rights Act does not include an explicit article relating to a ‘right to housing’, although article 8 includes a right for

respect for the home you already have. A ‘home’ can include hospitals, care homes and in-patient settings if a service user has

been living there for a significant period of time. It certainly includes supported housing.

The FREDA principles need serious consideration when dealing with housing issues. For example, it is necessary to ensure service

user inclusion in decisions relating to where they want to live and how they are supported within their home (e.g. does the service

user have access to help and information regarding housing?).

Article 8 A right for respect for home is clearly pertinent, for example, is the place where the service user lives respected as their home by

support staff and other professionals?

Article 8 also highlights that a person should be given privacy within their home and personal life, which includes whether bathroom

doors can be shut and if the service user can have privacy to speak to friends and relatives.

Article 5 It is possible that the right to liberty could be implicated in housing issues if there are locks or security devices placed on doors or

windows to prevent the service user leaving their home.

0 No Unacceptable

1 Yes There are some aids in place, but more would be beneficial.

2 Yes The house or fittings have been adapted accordingly or N/A

0 No This has not been considered

1 Yes Some of the information is available in an appropriate format.

2 Yes All information is available in an appropriate format.

0 No This issue has not been considered with respect to the service

user in question (e.g. CCTV may be used despite the fact that

it is not necessary for this service user).

1 Yes This issue has been considered with respect to the service

user in question, and a compromise has been reached (e.g.

CCTV in communal areas only if necessary)

2 Yes No CCTV is used or CCTV is used only as a direct result of a

threat either to the service user or from the service user to

another individual. All other methods of reducing this threat

were exhausted before the introduction of CCTV, and this issue

has been discussed with the service user.


1 Yes The tenancy agreement has been discussed with the service user

2 Yes The tenancy agreement has been discussed with the service user

and they have been given an easy-read version of the agreement

to keep.

0 No This issue has not been considered.

1 Yes This has been considered or discussed with the service user, but

is inconsistently implemented

2 Yes This has been fully considered and discussed with the service

user, and the service user’s preferences are fully met.

0 No This has not been considered.

1 No This has been considered appropriate for well documented

reasons and is regularly reviewed. The service user is aware of

the reasons.

2 Yes But this is regularly reviewed. The service user is aware that this

is under regular review.


1 Yes The service user is involved in decisions about their bedroom.

2 Yes or N/A Decisions for the house were fully informed by the service user.

0 No Visits are not facilitated

1 Yes But there are some restrictions (e.g. restrictions on visiting times,

staff must be present, prior arrangements necessary, doors left

ajar). These reasons are documented.

2 Yes Visiting times are fully flexible and visits can be arranged for

people who live far away.

1 Have the service user’s physical

mobility and sensory impairment

needs been considered?

2 Is information within the house

provided in an appropriate

format (e.g. Braille, easy-read,

minority languages)?

3 Is the service user’s privacy

respected by refraining from the

use of CCTV?

4 Is the tenancy agreement

accessible to the service user?

5 Is the tenancy respected as the

service user’s home? (E.g. do

staff and the service users use

the same facilities and do staff

always knock before entering

the service users bedroom?

6 Does the service user have a

house key or the code for the

door?


decisions about decoration and

furnishings?

8 If they wish to, can the service

user receive visitors at any time?

0 No Unacceptable

1 Yes There is written information available/advocacy has been


2 Yes An advocate has visited the service user to discuss the service

that they offer.

0 No Unacceptable

1 Yes But this has not been discussed with the service user.

2 Yes This is discussed with the service user and is available in easy-read.

0 No Unacceptable

1 Yes The service user was not involved

2 Yes The service user was involved

0 No Unacceptable

1 Yes The service user has been informed of this.

2 Yes The service user was involved in developing this process and fully

understands the conditions of their tenancy including potential reasons

for eviction.

9 Has the service user been told

about advocacy services?

10 Is there a procedure for making

complaints, suggestions and

changes and are these acted

upon?

11 Have steps been taken to

ensure reduction in the service

user’s vulnerability to

discrimination in the community?

12 Is there a clearly defined

tenancy agreement including the

process for eviction?



9. Housing (B) (To be completed only when choosing new accommodation with regard to first choice.)

0 No No service specification has been written or none of the documents

listed were taken into account when writing it.

1 Yes Some of the documents listed were taken into account.

2 Yes All of the documents listed were taken into account.

0 No Unacceptable

1 Yes The service user has been asked for their views regarding the

accommodation.

2 Yes The service user’s preferences have played an important role in

decisions and have been met where appropriate.


1 Yes The service user has been asked for their views regarding the location.


decisions.


1 Yes The service user has been asked for their views regarding housemates.


decisions and have been acted on where appropriate.


1 Yes The service user will be able to meet housemates and staff before the

move.

2 Yes The move will be undertaken in stages with the service user spending

time with their new staff before moving and their old staff after moving.

If possible the service user will also stay overnight before the move.

0 No This issue has not been considered with respect to the service user in

question (e.g. CCTV may be used despite the fact that it is not

necessary for this service user).

1 Yes This issue has been considered with respect to the service user in

question, and a compromise has been reached (e.g. CCTV in communal

areas only if necessary)

2 Yes No CCTV is used or CCTV would be used only as a direct result of a

threat either to the service user or from the service user to another

individual. All other methods of reducing this threat would be exhausted

before the introduction of CCTV, and this issue would be discussed with

the service user.

0 No Unacceptable

1 Yes The house will need some adaptation in order to meet the service user’s

needs.

2 Yes The house needs no adaptation / all adaptations have already been

made.


1 Yes Some of the information is available in an appropriate format.

2 Yes All information is available in an appropriate format.

1 Has a service specification beenwritten that takes into account:• HR-JRAMP• Essential Lifestyle Plan• Health Needs Assessment• Pro-active and reactive

strategies• Early warning signs of relapse

2 Has the accommodation on offerbeen discussed with the serviceuser and their preferences takeninto account?

3 Have the service user’spreferences regarding locationbeen considered?

4 Have the service user’spreferences regardinghousemates (e.g. gender, age)been considered?

5 Will the service user beintroduced to housemates andstaff before the move?

6 Is the service user’s privacy berespected by refraining from useof CCTV?

7 Have the service user’s physicalmobility and sensory impairmentneeds been considered?

8 Is information within the houseprovided in an appropriateformat (eg Braille, easy-read)?

0 No Unacceptable


2 Yes Service user involved.

0 No Visits are not facilitated

1 Yes Visits are facilitated when possible/appropriate

2 Yes Visits are facilitated when requested and visiting time are flexible

according to risk assessments

0 No This is an out of area placement so transport would be difficult.

1 Yes If appropriate, the service user will be able to have access to family

and friends.

2 Yes If appropriate, staff will facilitate access to family and friends.

0 No Visits will not be facilitated.

1 Yes But there will be some restrictions (e.g. restrictions on visiting times,

staff must be present, prior arrangements necessary, doors left ajar).

These reasons are documented and explained to the service user.

2 Yes Visiting times will be fully flexible and visits can be arranged for people

who live far away.


9 Have steps been taken toensure reduction in the serviceuser’s vulnerability todiscrimination in the community?

10 Will the service user besupported to visit family andfriends/receive visitors at anytime?

11 Will the service user haveaccess to family and friends (i.e.is the accommodation close tofamily)?

12 Will the service user be able toreceive visitors at any time?


10. Additional Factors

It is important to consider any relevant life events or deterioration in physical or mental health and their potential impact on this

assessment. This may include bereavement, recurrent episodes of psychosis or physical health concerns. Please use the space

below to write any additional relevant information.

Improving Mental Health

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