Bill of Patient Rights

The Bill of Patient Rights has been developed to assert and promote the dignity and worth of all of the people who use the services of the Centre for Addiction and Mental Health (CAMH). The Bill of Patient Rights expresses the truth that patients are people who possess the same fundamental human rights extended to all Canadians, and that CAMH is committed to upholding all of those rights. The patients, families and staff of CAMH who have worked together to develop the Bill of Patient Rights want it to be a living document that will grow and change as it helps to foster an organizational culture of mutual respect. The Bill of Patient Rights is intended to ensure that organizational convenience does not take priority over the protection and promotion of patient rights.

CAMH is committed to upholding the rights and patients have a right to expect that the policies and procedures at CAMH reflect and are consistent with those rights. It is important to note that some of these rights may be subject to limitations (e.g., by legislation, court order and/or availability of resources, working in good faith). Rights may also at times be restricted reasonably to ensure the protection of the rights and safety of the individual and/or others. The restriction of some rights leaves other rights intact.

The Board of Trustees of the CAMH endorses the Bill of Patient Rights and, in so doing, expects that CAMH and every one working at CAMH – including volunteers and students – will uphold the Bill of Patient Rights; will promote awareness and understanding of the Bill of Patient Rights; and will interpret the Bill of Patient Rights as broadly and generously as is consistent with their responsibilities to patients. CAMH commits to ensuring that every patient is offered a written copy of, and assistance in understanding, the complete Bill of Patient Rights, and to posting its 10 core principles at CAMH's main entrances and other places across the organization where patients receive services. 

CAMH Bill of Patient Rights

1. Right to be Treated with Respect.
2. Right to Safety and Protection from Harm.
3. Right to Dignity, Independence, and Self Determination.
4. Right to High Quality Services that Comply with Standards.
5. Right to Clear and Supportive Communication.
6. Right to be Fully Informed.
7. Right to Direct Treatment Decisions.
8. Right to Support.
9. Right with Respect to Research and Teaching.
10. Right to Make a Complaint.

Right #1: Right to be Treated with Respect

Every patient:

1. is a person first, with the right to this recognition and to respect before the law;
2. has the right to be treated without bias, and with sensitivity to the effects that a history of marginalization and discrimination may have on their well-being;
3. has the right to be treated without discrimination, and to have their culture, spirituality, atheism, or identity respected;
4. has the right to be treated with kindness and compassion, and to be allowed a range of feelings and to receive validation for those feelings, without negative consequences for their expression; and
5. has the right to have their time valued.

Right #2: Right to Freedom from Harm

Every patient:

1. has the right to protection from abuse, indifference, denial of care, retribution, punishment, and unjustified interventions;
2. has the right to the least restrictive environment and to be offered the least intrusive treatment;
3. has the right to be free from restraint in accordance with the law, and be restrained only after all efforts to reach resolution and de-escalation have been tried. Patients will be informed how to be released from restraint, will be offered a supportive and respectful debriefing, and will be involved in reviewing and revising their care plan if needed; and
4. has the right to a safe and comfortable sleeping environment, with every possible effort to make it quiet.
   

Right #3: Right to Dignity, Independence and Self-Determination

Every patient:

1. has the right to all freedoms in accordance with the law;
2. has the right to receive rights advice in accordance with legislated rights when decisions are made that impact their liberty, for example when detained involuntarily, being found incapable of making decisions about treatment or property, or when a Community Treatment Order is issued or renewed;
3. has the right to treatment and services that preserve and enhance dignity, independence, and self-determination;
4. if unable to leave a unit, has the right to be told why, and how to be able to leave (e.g., passes, detention orders, etc.);
5. has the right to challenge certain decisions that impact their liberty (i.e., when they are involuntarily detained or found incapable of consenting to treatment or management of property), and to leave hospital if their application challenging an involuntary detention is successful;
6. has the right to have their privacy respected in the company of other people;
7. has the right to have access to their spiritual care or cultural advisors, and to exercise religious, spiritual, and cultural observances, rituals, customs, diet, and dress;
8. has the right to retain and use personal possessions – except where it may pose a risk of harm to themselves or others. CAMH has a duty to provide space for personal possessions of a spiritual or cultural nature;
9. has the right to privately access toilet facilities;
10. has the right to a sexually safe environment that promotes privacy, is respectful of intimacy needs and allows for healthy sexual expression, ensures patients have access to private bedroom space, and provides information on contraception, safer sex, and the impact of treatments on sexuality;
11. who is eligible to vote, has the right to information and support to register to and cast a vote; and
12. has the right to self-identify and be recognized for their gender, gender identity, gender expression and sexual orientation, including but not limited to name, pronouns, and expression.

Right #4: Right to Quality Services that Comply with Standards

Equitable access
Every patient:

1. has the right to fair and equal access to and choice from the range of CAMH treatments and services available (both clinical and non-clinical), and to culturally-based healing modalities (e.g., smudging, etc.), and to reasonable accommodations that are required to support their participation;
2. has the right to be treated with fairness, in a manner that is respectful of patient-identified needs and preferences;
3. has the right to recovery oriented, trauma-informed and trauma based care, including support with experiences of abuse and other forms of trauma;
4. has the right to have their health record include only relevant facts, and not speculation or prejudice;
5. has the right to be provided with sufficient, nutritious and appetizing food, to have any special dietary needs met, to have preferences for vegan and vegetarian food provided for, and to have requests for faith-based meals accommodated;
6. has the right to consistent access to patient-centred education and recreation; and
7. has the right to provide feedback about their care and to participate in opportunities aimed at improving the quality of services. 

Empowerment
Every patient:

1. has the right to identify their own needs and to have those be the basis of any plan of care;
2. has the right to an individualized written plan of care and service, the opportunity to consent, and the right to a copy thereof;
3. has the right to express a preference in service providers and outpatient treatment teams and have that preference taken into consideration;
4. has the right to seek an additional medical opinion;
5. has the right to daily access to exercise;
6. has the right to daily access to the outdoors, in accordance with the law;
7. has the right to review documentation that explains why rights are restricted and information on how to have those restrictions removed; and
8. has the right to collaborate in the development of a discharge plan with a housing option, and assistance in accessing outpatient supports and making referrals.

Right #5: Right to Clear and Supportive Communication 

Every patient:

1. has the right to clear, honest, direct and supportive communication with service providers that recognizes and seeks to mitigate the power imbalance and its impact (e.g., clear language, transparency, how to participate to reach own ends, etc.);
2. has the right to collaborative and patient-centered engagement through all aspects of care; and
3. has the right to translation of care and rights related services and materials to a preferred language through cultural interpretation services - including translation in a heritage language.

Right #6: Right to be Informed

Every patient:

1. has the right to be informed about and offered a copy of this Bill;
2. or substitute decision-maker (SDM), has the right to information (in writing, if requested), about:
   a. the perceived problem, diagnosis or condition, and proposed treatment;
   b. alternative options/treatments, including none;
   c. the benefits, risks, side-effects, and costs (if any) of these options – including long-term and permanent risks;
   d. the likely consequences of not having the treatment;
   e. the results any of tests and procedures; and
   f. responses to requests for additional information about any of the above.
3. has the right to meaningful answers to questions about services, including requests for:
   a. the full name, qualifications, and scope of practice of the provider;
   b. the recommendations for treatments or services;
   c. where to access additional information and how to obtain an opinion from another provider; and
   d. notification of any developments in the area of that treatment;
4. has the right to view their health record and be informed how to access it;
5. has a right to information about implied consent, and how CAMH may collect, use and share health information with internal and external providers;
6. has a right to be told if their information is lost, stolen or shared without authorization;
7. has the right to correct their health record or to add a statement of disagreement in accordance with the law, and to choose to secure part(s) of their record for additional privacy under a Consent Directive where the law permits; and
8. has the right to information if requested about relevant clinical services, such as rules, policies, procedures and any applicable rights, and have access to that information in writing and/or online (if available).

Right #7: Right to Direct Treatment Decisions 

Every patient:

1. if capable, has the right to direct their treatment by making decisions about any proposed treatment and to ask staff for information (in writing, if requested) that is needed to understand and make decisions (i.e., about treatment recommendations) and to receive it;
2. unless found incapable, is presumed to have capacity to make treatment decisions;
3. if found incapable, has the right to expect that their SDM will make decisions on their behalf in accordance with their legal obligations (including taking into account any prior wishes expressed by the patient while capable that apply in the circumstances);
4. if capable, must give voluntary, informed consent before each treatment or plan of treatment can commence and has the right to withdraw that consent at any time. This right cannot be waived; and
5. if capable, has the right to receive support from family members/friends in making their decisions about treatment, and to be given time to discuss and make such decisions.

Right #8: The Right to Support

Every patient:

1. has the right to be supported by their treatment team in arranging visits with persons they choose, and assistance in making contact with their proposed visitors;
2. has the right to request that a third party be present during a physical examination;
3. has the right to access supports with all possible privacy and confidentiality when needed;
4. assistance in securing financial, housing, recreation, employment, social, and community supports to meet individual needs;
5. has the right to a discharge plan that aids in the transition to community living.

Right #9: Rights in Respect of Research or Teaching

Every patient:

1. unless there is an emergency, has the right to decline student involvement – excepting psychiatric residents;
2. has the right to give informed consent for participation in research or as otherwise as determined by the Research Ethics Board;
3. who consents to participate in research has the right to be informed of research goals and results;
4. ineligible for research has the right to be informed of available treatment options; and
5. has the right to decline involvement in research, where consent is sought, at any time without impact on access to care, treatment, or services.

Right #10: Right to Make a Complaint

Every patient:

1. has the right to make a complaint, raise concerns, and recommend changes without fear of interference, coercion, or reprisal;
2. has the right to make a complaint and give feedback through the CAMH Client Relations Office (CRO) and has the right to appeal any decision from that office;
3. has the right to get rights advice and raise concerns or make a complaint through the Psychiatric Patient Advocate Office (PPAO), which is independent of CAMH;
4. has the right to provide oral or written complaints;
5. has the right to be supported by a family member or friend in making or pursuing a complaint;
6. can make a complaint to any other service provider or organization (e.g., Patient Ombudsman or professional regulatory Colleges, etc.); and
7. has the right to inform the Empowerment Council (EC), an independent peer run systemic advocacy organization, of their complaint(s) to seek systems change and systemic advocacy.