Brothers of Charity Services Ireland – Galway Human Rights Committee Presentation at Inclusion Ireland National Learning and Sharing Event 15th June 2017 Breda Golden bredagolden@Galway.brothersofcharity.ie

Background and Laying the Foundation First meeting July 2007 – 10 years in operation Idea from organization as part of the accreditation process with the Council for Quality & Leadership (CQL) - importance of external representation and due process Human rights seminars for staff, service users and family members in partnership with Amnesty and the BOC Training and Development Department Policies and procedures developed by Committee (with senior management support) and put on website Referrals from June 2008

Brothers of Charity Services Ireland – Galway Policies and Procedures Policy on Human Rights and the Human Rights Committee Procedures for the Operation of the Human Rights Committee Brothers of Charity Services Charter of Rights Policy and Procedural Guidelines on Moving Towards a Restriction Free Service Closed Circuit Television (CCTV) Policy and Guidelines Human Rights Referral Form Individual Rights Assessment Form (as part of each service user’s Individual Plan)

Composition 2 Service Users from the Service Users’ Council 4 external (NUIG Centre for Disability law & Policy, retired consultant Paediatrician, Social Worker from local Service Provider) 1 vacancy due to recent retirement 6 internal (2 Social Work, Quality and Development, Psychology, Speech and Language, Service Co-ordinator) Role of Chairperson is allocated to an external member

Referral Process Informal contact about referrals – clearly stated in policies that there is a requirement to submit any rights restriction to HRC Referrals welcomed from family members, service users and staff Human Rights Restriction Form and supporting documentation submitted Screening prior to HRC meeting to establish if case should be heard, or if more information required Formal notification to person who submitted form regarding status of referral Email inviting service user, family, staff and any other relevant persons to the HRC Screening did exist before, but now has external representation. For practical purposes done internally. Moving towards formal notification system – written record of submission. This is currently being developed.

Procedure at Meetings External representative chairs the meeting Present who the person is, their quality of life and lifestyle preferences Present reasons for right being restricted Person subject to rights restriction (and support person(s)/advocate(s)) given opportunity to speak HRC ask questions about facts and alternative approaches, what has been done to reduce or remove restriction HRC reach decision and formally notify parties in writing of their recommendations Director of Services and Sector Managers receive a copy of recommendations HRC encourage broad representation of those involved and broad representation of opinions. The CEO is also notified of decisions of HRC.

Types of restrictions Rights restriction Examples Freedom of movement Locked doors, restricted access to garden/kitchen/road, stairgate, harness, bedrails, wheelchair Privacy CCTV, monitors, alarms, supervised access to the community Choice of where and with whom to live Inappropriate/unsuitable living conditions, incompatibility issues Making decisions Cigarettes, matches, access to money, refusing medication, locked wardrobe/cupboard, restricted access to family, restricted access to food/water Bodily integrity Psychotropic medication, covert medication, blood protocol, protective headgear Appropriate support Appropriate housing, limited community access Locked doors (1 in 2009 (access to outdoors), 3 in 2010), Access to kitchen (2 in 2010), seclusion (2 in 2010), alarm (1 in 2010), harness (2 in 2011). Seclusion – person placed in room during day programme for 5 minutes when displayed aggressive behaviour. Partition between two day programmes. Cameras (1 in 2009, 1 in 2010 – more cameras needed for changing behaviour? Raised in 2011), supervision for user (1 sexual abuse, 1 road safety – 2009) Inappropriate housing 2 in 2010), dispute among service users (1) – but environmental/housing issues often raised as part of presentation of other issues to HRC. Choice of living alone? Cigarettes (1 in 2009, 1 in 2010 – possibly inappropriate referral) Eating (1 in 2009, same in 2010), Refusing medication (1 in 2009, same in 2010) Helmet (1 in 2010) Risks (2 suicide risks, 1 sexual risks) Psychotropic med (2 in 2010), covert medication (1 in 2009), Blood protocol (1), washing (1 in 2011) Appropriate support (1 respite 2010), appropriate housing (2 in 2011), feeding (1)

Key figures Human Rights Committee meet 11 times per year for 3 hours June 2008 – June 2009 = 18 referrals January – December 2014 = 39 hearings January – December 2016 = 93 hearings (Committee divided into 2 groups on 4 occasions and 1 day long meeting) Referrals from Adult and Children’s services (residential, day, home sharing) Currently 105 open to HRC including 21 on waiting list Reviews 6 months – 2 years Future issue: reporting – September to July? Don’t meet in August – stats should reflect this. Would accept children’s referrals but would ask parents to be present.

Positive outcomes HRC seen as a support for staff, not a threat High attendance of service users Staff often come to HRC with solutions or issues resolved before meeting Annual report to Services Management Team Cultural change in organisation (e.g. cameras, skills building, use of technological aids) HRC visiting places where people live Impact on organisational decisions (e.g. when and where to move people) Reduction in levels of restrictions for significant number Comprehensive Human Rights database accessible to managers and relevant staff e.g. HRC provide support to psychiatrist re issue of covert medication and generally in her work.

Learning Composition of Committee – recruit a parent representative Reflective Practice Commitment of Committee members Clear leadership and Support of Director of Services and Managers Definition and understanding of what is a rights restriction Understanding the purpose of the HRC – not to resolve internal disputes which are not related to rights restrictions Supporting documentation with referral (risk assessments and protocols, behavior support plans) Process is viewed positively by HIQA

Challenges Lack of clarity on legal positions e.g. re capacity Increase in the number of referrals and waiting times Participation of family in HRC meetings Resource issues and timeframes related to rights restrictions (housing, staff shortages) Balancing rights (e.g. right to health v. right to make decisions, rights of service users v. staff/families, risk v. safety) Refer back to internal disputes issue in balancing rights – need to hear opinions of wider group involved, not just views of one or two staff. Challenge: because we are welcoming referrals from as wide a range of people as possible.

Future issues Scheduling presentations and reviews in a timely manner Sharing the learning (within and outside organisation) Regular awareness raising with staff Reviewing and follow up on recommendations, requests for further information Children’s sector – East and West? Adult sector? Issues for Database records. Staff have made the HRC work. Have been comfortable in making referrals.