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Reflections About Safety, Part 4: Self-Empowerment and the Grievance Process When Rights Are Violated

May 20, 2022 / Mental Health

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by Diana Spore, PhD, MGS, and Steven G. Stone, MA

This is the fourth part in a four-part series about safety.

This final blog in the safety series addresses self-empowerment, awareness and preservation of rights and the process of filing grievances when rights are violated. To read the previous installments in the series, check out Part 1, Part 2 and Part 3.

Self-Empowerment

Fears about safety and your experiences with feeling unsafe can be traumatizing and overwhelming. You may feel as if you are all alone, and that it is better that way. However, as addressed in Part 2 of this series, you can empower yourself when facing safety concerns by creating safety plans and having psychiatric advance directives in place. These concrete, thoughtfully developed and tangible documents will provide you with a sense of control over a perceived or actual threat.   

Also, you can also promote a sense of safety and self-empowerment by making self-care a priority, remaining healthy, maintaining your emotional well-being, being assertive and engaged, and becoming more resilient. “Our Human Community:  Supporting and Promoting Attitudes and Services That Do No Harm” (Stone et al., 2019) is an excellent resource that captures what resiliency means and how it relates to and is intertwined with recovery. 

To cope and deal well with safety threats, which can be traumatizing, it is essential to build resilience. Being resilient means holding on to the strength within, reaching out for assistance or information when you need it, and embracing the realization that you are not alone. 

“Our Human Community” explains that one key component to “developing, maintaining and recovering resilience” is having “at least one safe, stable, committed and trusting relationship with another person in your family or community.” 

In reflecting on your safety concerns and your potential fears about sharing them with a mental health professional, is that relationship one that fosters resilience? Or is it a major barrier to strengthening resilience? Being empowered and dealing with safety concerns means not only having “external” protective measures in place but also having “intrinsic” or internal strengths. In short, being empowered translates into the recognition that you are and should be the primary decision-maker about your mental health care and the strategies you will engage in to remain safe.   

Awareness of Rights

It is essential to be aware of your rights, whether you are someone with a psychiatric diagnostic label, a psychiatric disability, a substance use disorder, an outpatient mental health consumer or an inpatient in a psychiatric hospital, ward or unit. While these rights will be addressed in greater depth in a mental health advocacy guidebook that will be released later this year, this blog will address key points.   

Disability Rights Ohio provides a listing of rights specific to different mental health settings, including residential centers, private psychiatric hospitals/units, community mental health centers, and state psychiatric hospitals. As an example, click on to the section addressing community mental health centers, which may be your first stop for receiving mental health care. While the provided list of rights does not include complete rule text from the Ohio Administrative Code 5122:2-1-02, a link allows you to access the complete text. Rights related to community mental health center services include:

  • The right to receive services in the LEAST RESTRICTIVE setting;
  • The right to be treated in ways that are respectful and honor your dignity, privacy and autonomy;
  • The right to not be medicated (psychiatric medications) unnecessarily or excessively;
  • The right to not be unnecessarily restrained or secluded;
  • The right to file a grievance or complaint, and to be provided with instructions on doing so in writing and orally;
  • THE RIGHT TO BE FULLY INFORMED OF ALL RIGHTS.

During any admission to out-patient or in-patient services, the provider is REQUIRED to verbally review the client rights and grievance procedures. This information should be provided in writing. The grievance procedure document will identify the name of the client rights officer that the provider (e.g., mental health agency or community mental health center) is REQUIRED to have along with a clear description of how to use their services. The provider is REQUIRED to give you copies of both documents. You should be asked to sign a form to confirm that you have been provided with this information.

However, it must be noted that when hospitalized for psychiatric reasons, many patients are in crisis during the admission process. The admission process may be chaotic, confusing and frightening, especially if you have been transported and admitted involuntarily. When you arrive and are admitted, the process usually entails receiving – what feels to be rapidly – numerous forms that need to be signed. There is a distinction between acknowledging receipt of information and comprehending or understanding what you have been told or read. In a crisis situation, you may not remember that your rights or grievance processes were discussed.   

Reaching Out When Rights are At Risk or Violated – Filing Grievances

The Ohio Department of Mental Health Addiction Services (OhioMHAS) Client Rights page provides a lot of information, including Clients Rights Officers that are affiliated with Ohio Mental Health and Recovery Boards by county, client rights and grievance procedures, resolution of grievances, and Ohio laws (Revised Code and Ohio Administrative Code). 

Ohio’s mental health system has a grievance process. As noted above, it is your right to file a grievance or complaint and to be informed about how to proceed. Brief descriptions of informal grievance resolution, formal grievance resolution and how to appeal a decision about your grievance are provided on the OhioMHAS Grievances page.

Ohio Mental Health and Recovery Boards engage in protecting the rights of those who seek or receive mental health and/or drug addiction services. They can assist you with your efforts to file a grievance. Visit the Ohio Association of County Behavioral Health Authorities website for more information about these boards.

Concluding Comments

This safety series has addressed issues from the patient’s perspective – the risks of opening up about feeling unsafe and about having suicidal ideation. It’s important to have legal documents set in place, including naming a proxy who can speak on your behalf and serve as a “protector” if issues arise about your competence and mental health status (e.g., being delusional or suicidal). Be self-empowered by building resilience, staying connected with at least one person that you trust completely, and prioritizing self-care to maintain mental health.

The blog series also addressed issues from the mental health expert’s perspective, what is useful for the mental health consumer as well as the mental health professional to know. With regard to those who provide mental health care, there needs to be a focus on providing support, acknowledging that safety threats may appear to be delusional but are rooted in powerful feelings and may, in fact, be real. Conversations with mental health consumers or those with psychiatric disabilities who feel unsafe must be trauma-informed, trauma-responsive and “safe,” with no looming, underlying threat of being shipped off to a psychiatric ward involuntarily.

Finally, in this final segment of the series, we explain the importance of knowing your rights – as an outpatient mental health consumer, as someone with a psychiatric disability and/or substance use disorder, and as a hospitalized psychiatric inpatient. Take action if your rights are violated, familiarize yourself with resources and appropriate contacts of who to reach out to when you want to file a grievance or complaint.

Safety threats can be very real, traumatizing and can adversely affect your emotional well-being, your ability to function well and your health. You deserve to be treated with respect, with understanding of your past traumas, and with support from those who you reach out to for help.

Diana Spore is an advocate for individuals facing mental health challenges and those who are living with dementia, a writer/editor, and a mental health consumer in recovery. Spore received her Master’s degree in Gerontological Studies from Miami University (Ohio), and earned a PhD in Human Development and Family Studies, with a concentration in aging, from Penn State. She completed postdoctoral training at Brown University. Spore’s areas of expertise include mental health and aging, mental health recovery and trauma-informed care, medication optimization, long-term care, caregiving, and psychotropic drug use and inappropriate drug use among older adults. She is a former Board member of the Mental Health and Recovery Board of Ashland County (Ohio; MHRB). She was Editor-of-Chief of TAPESTRY OF OUR LIVES, an anthology of works created by individuals in recovery, a project that was done under the auspices of the MHRB. Spore served as Project Lead for a “Writing for Recovery” initiative, MHRB, and engaged in all aspects of the project, which has resulted in sustained spin-off efforts. Diana Spore has expertise in creative writing, writing for recovery, journaling for caregivers, legacy writing, and advocacy writing.

 

Steve Stone is Executive Director Emeritus of the Mental Health & Recovery Board of Ashland County Ohio. He retired in 2020 after serving as the executive director of the county mental health board for 18 years. He was the primary author of “Our Human Community” and served as a counselor, administrator, and advocate in the community behavioral health system for over 40 years.

Mr. Stone holds a Bachelor of Arts in religion/education and a Master of Arts in pastoral counseling and psychology from Ashland Theological Seminary. He received his clinical training at the Cleveland Psychiatric Institute and Case Western Reserve University. In addition, he completed extensive post-graduate studies in Public Policy and Social Change at Union Institute and University. He completed the Mental Health Executive Leadership Program at Case Western Reserve University and is an approved Mental Health Mediator.

Steve was licensed as a Professional Clinical Counselor with a Supervisory endorsement in 1989 and maintained a private counseling practice in Ashland for 15 years. Mr. Stone has served as the director of a not-for-profit community behavioral health agency and directed a mental health program for a county juvenile court. In addition, he has been an adjunct faculty member at Ashland University and Franklin University.

Steve has been an active member of his community in Ashland, Ohio, since moving there in 1979. He is the co-founder of the Annual Pat Risser RSVP Recovery Conference, past-president of the Rotary Club of Ashland and past-chair of the Leadership Ashland Advisory Council. He is currently on the board of North Central State College, where he served as board chair for two years and has served on a number of other community and non-profit boards. In addition, Steve is on the Board of Directors of the Academy of Violence and Abuse, an international healthcare organization whose mission is to address the long-term health effects of violence and abuse and to prevent their occurrence. Steve and his wife Marilyn have two adult sons and three grandchildren and live in rural Ashland County.