Patient Rights and Advocacy Commission, Inc.

The following are excerpts of the rights that are generally guaranteed for psychiatrically
institutionalized individuals. These standards, or rights, were originally established in 1972 and
are reported at 344 F. Supp. 373, 379 (M.D. Ala. 1972). These rights were amended in 1980,
and the standards were again amended in 1992 and are reported at Rawlins v. King, 793 F.
Supp. 1058, 1071 (M.D. Ala. 1992).

For convenience, the rights are listed in alphabetical order by subject and not in the order in
which they appear in the court orders. Some definitions and details are omitted.

Definition: A qualified mental health professional (QMHP), as discussed below, includes a
psychiatrist or psychologist.

Access to and Confidentiality of Medical Records (1992)
Confidentiality of the patient record shall be protected. … [The patient shall have access to
his/her own record].

Access to Counsel and Health Professionals
Patients shall have an unrestricted right to visitation with attorneys and with … health
professionals.

Clothing
Patients have a right to wear their own clothes and to keep and use their own personal
possessions except insofar as such clothes or personal possessions may be determined by a
Qualified Mental Health Professional to be dangerous or otherwise inappropriate to the treatment
regimen. The facility has an obligation to supply an adequate allowance of clothing to any
patients who do not have suitable clothing of their own. Patients shall have the opportunity to
select from various types of neat, clean, and seasonable clothing. Such clothing shall be
considered the patient’s [personal property] throughout his stay in the facility.

Exercise and the Outdoors
Patients have a right to regular physical exercise several times a week [and to be furnished]
facilities and equipment for such exercise. Patients have a right to be outdoors at regular and
frequent intervals, in the absence of medical considerations.

Humane Environment
A patient has a right to a humane psychological and physical environment. … [F]acilities shall be
designed to afford patients with comfort and safety, promote dignity, and ensure privacy. The
facilities shall be designed to make a positive contribution to the efficient attainment of the
treatment goals of the facility … [The standards describe minimal requirements for resident
units, toilets and lavatories, showers, day rooms, dining rooms, linen service, housekeeping,
heat, fire and safety, water temperature, and refuse management.]

Labor
No patient shall be required to perform labor which involves the operation and maintenance of
the facility or for which the facility is under contract with an outside organization. … Patients
may voluntarily engage in such labor if the labor is compensated in accordance with the
minimum wage laws of the Fair Labor Standards Act. … Patients may be required to perform
tasks of a personal housekeeping nature such as the making of one’s own bed. … Payment to
patients pursuant to these paragraphs shall not be applied to the costs of hospitalization.

Least Restrictive Conditions
Patients have a right to the least restrictive conditions necessary to achieve the purposes of
commitment.

Mail
Patients shall have an unrestricted right to send sealed mail. Patients shall have an unrestricted
right to receive sealed mail from their attorneys, private physicians, and other mental health
professionals, from courts, and government officials. Patients shall have a right to receive
sealed mail from others, [but that mail may be required to be opened in front of staff. Staff may
not read the mail, only inspect the envelope, etc., for contraband

Managing One’s Affairs
No person shall be deemed incompetent to manage his affairs, to contract, to hold professional
or occupational or vehicle operator’s licenses, to marry and obtain divorce, to register and vote,
or to make a will.

Medical Care
Patients have a right to receive prompt and adequate medical treatment for any physical
ailments.

Medication
Patients have a right to be free from unnecessary or excessive medication. … At least weekly,
the attending physician shall review the drug regimen of each patient under his care. All
prescriptions shall be written with a termination date, which shall not exceed 30 days.
Medication shall not be used as punishment, for the convenience of staff, as a substitute for
program, or in quantities that interfere with the patient’s treatment program.

Nutrition
Patients, except for the non-mobile, shall eat or be fed in dinging rooms. The diet for patients
will provide at minimum the Recommended Daily Dietary Allowances as developed by the National
Academy of Sciences. Menus shall be satisfying and nutritionally adequate. … Provisions shall be
made for special therapeutic diets and for substitutes with the religious requirements of any
patient’s faith.

Privacy and Dignity
Patients have a right to privacy and dignity.

Quality Assurance/Release (1992)
Each facility shall have a Quality Assurance Program that provides for all treatment plans to be
reviewed in accordance with JCAHO standards and a Utilization Review Program that requires
that all patients be screened for appropriateness of admission to the facility [and continued
hospitalization] according to specific criteria, including whether the patient meets the standards
for commitment.

Religious Practice
The right to religious worship shall be accorded to each patient who desires such opportunities.
Provisions for such worship shall be made available to all patients on a nondiscriminatory basis.

Seclusion and Restraint (1992)
Patients have a right to be free from seclusion and physical restraint. Patients may be placed in
seclusion or physically restrained only:
(a) To prevent a patient from physically injuring himself/herself or others;
(b) After alternative treatment interventions have been unsuccessful or after determining that
alternative treatment interventions would not be practicable; and
(c) When authorized by a written order of a qualified physician who is physically present and
has examined the patient. No order for seclusion or restraint may exceed eight hours.
Seclusion or restraint shall not be used as punishment or for the convenience of staff or in a
manner that causes undue physical discomfort, harm, or pain to the patient. [As needed] orders
for seclusion or restraint are prohibited.

Socializing with the Opposite Sex
The institution shall provide … suitable opportunities for the patient’s interaction with members
of the opposite sex.

Telephone and Visitation
Patients shall have the same rights to visitation and telephone communications as patients at
other public hospitals, except to the extent that the QMHP responsible for the formulation of a
particular patient’s treatment plan write an order imposing special restrictions. The written order
must be renewed after each periodic review of the treatment plan if any restrictions are to be
continued.

Treatment Plans (1992)
Each patient shall have an individualized treatment plan developed by an assigned treatment
team. The team shall actively involve the patient, and with the patient’s permission, the
patient’s family, in developing the plan. [The plan must contain, at minimum:]
1) A statement of the nature of the specific problems and specific needs of the patient;
2) A statement of the patient’s strengths including skills and interests;
3) A statement of the least restrictive treatment conditions necessary to achieve the purposes
of commitment and the goals of the treatment plan;
4) A description of intermediate and long term treatment goals which relate to involuntary
commitment criteria, with a projected timetable for their attainment;
5) A specification of staff responsibility and a description of proposed staff involvement with the
patient in order to attain these treatment goals;
6) Specific and measurable criteria for release to less restrictive treatment conditions, and
specific and measurable criteria for discharge which relate to involuntary commitment standards.
These criteria shall be written in non-technical language and shall be explained to the patient in
a manner appropriate to the patient’s capacity to understand.
7) An assessment by medical staff of any restrictions or limitations on physical activity;
8) An individualized discharge plan developed concurrently with the individualized treatment plan
that identifies the residential, clinical, social and vocational services the patient will require
upon discharge.

If any of these rights are violated, you have several options. Those options, in the order
of severity, are:
Grievance or hospital complaint;
Formal complaint to a licensing board or department; or
State or federal lawsuit

IF ANY OF THE ABOVE RIGHTS ARE BEING VIOLATED, YOU MAY FILE A COMPLAINT BY CLICKING
HERE.