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Abuse and Neglect: Awareness and Reporting for Individuals Labeled as Mentally Ill

This section provides information about physical, sexual and emotional safety both in the community or while in a psychiatric hospital. It is written for people receiving services: you are your own best advocate. It will also provide information to family members, advocates and others concerned about the safety and quality of life of people receiving mental health (MH) services. Abuse in institutions and other forms of violence will be talked about in a direct way.


Your Personal Rights

The rights discussed here relate directly to abuse and safety. In the back of this booklet you will find a more complete list of your rights as someone receiving MH services.

You have a right to safety.

This includes being safe where you live, whether in the community or in a psychiatric hospital. It also includes a right to safety with people you know, including family and staff members, as well as with strangers.

You have a right to be respected.

Each of us, no matter what our color, sex, abilities or age, has this right. Unfortunately, people who receive mental health services are often discriminated against and treated without respect. Staff members or people in the community may focus on lack of ability rather than your personal strengths. Regardless of these unacceptable attitudes, everyone has a right to be treated with dignity.

You have a right to have or not have a sexual relationship.

Each of us chooses with whom and when we want to be sexual. You have a right to permit or deny another person touching you.

You have a right to control your money.

Money is often a problem for women and men labeled mentally ill. Enough money for food, shelter and clothing is important to physical and mental health. You may be seen as an easy target by people you know and by strangers. People may bother you for money which you cannot afford to give away or for other items, such as cigarettes, if you smoke. Family members may try to control your money or other resources.

You have a right to treatment in a place that respects your freedom.

This may be one of the hardest rights to keep, especially in hospitals, because of the many controls placed on you. You have a basic right to treatment, as well as a current, written treatment plan which you have participated in creating. The focus should be on providing and receiving services which give you the greatest possible freedom.

You have a right to freedom from restraint or seclusion.

In a psychiatric hospital, you have a right to be free from drugs, physical restraints and isolation except in an emergency (an immediate danger to yourself or others). Seclusion and restraint are abused if they do not directly result from your dangerous behavior; for instance, if they result from behavior which staff members see as a ward disruption.

You have a right to refuse or accept suggested medication.

You should be given information about why a drug is being suggested, the expected benefits and side effects. When you are receiving community mental health services no one can tell you that you have to take medication. You cannot be put in a psychiatric hospital solely because you refuse to take medication.

If you are in a psychiatric hospital you cannot be forced to take medication except in an emergency (immediate danger to yourself or others). You can object to medication even if you have a court appointed guardian who thinks you should take it. If you choose to take medication, you can change your mind at any time.

You should be able to exercise these rights without being punished.

The law clearly says that you cannot be punished because you exercise your rights. Punishment can take many forms, including withholding treatment, being moved to another ward, losing privileges, or physical or emotional abuse.

Institutionalization does not change your basic rights as a citizen.

We all have certain rights under the U.S. Constitution. Examples are our rights to vote, to free speech and to be free from unreasonable searches of our body or belongings. You do not lose these constitutional rights just because you are in an institution or are receiving community MH services.

You have a right to a living space that gives you reasonable protection from harm.

Regardless of where you live, you have a right to be treated with respect and to live free from physical, sexual and emotional abuse.

Definitions

Physical Abuse

Physical abuse occurs when you are hit, kicked, slapped, beaten, punched, intentionally burned or physically hurt in some other way.

Physical abuse also occurs when

  • you are over-medicated.
  • you are forced to take medication in a psychiatric hospital without consent, except in an emergency (immediate danger to self or others). In the community you have the absolute right to refuse medication, and cannot be forced to take it for any reason.
  • too much force is used during restraint.
  • restraints or seclusion are used in a psychiatric hospital when you are not an immediate danger to yourself or another person.

Sexual Abuse

Sexual abuse is any unwanted or forced sexual touching or activity, including rape and incest. Infants, young and older people have been victimized. Men and boys, as well as women and girls, can be victims. Sterilization without knowledge or consent is also sexual abuse.

Rape is forced penetration of the vagina, anus or mouth by a penis or other object without your consent.

Incest is sexual activity between two people in a household (for example ã a parent, step or grand parent, mother's boyfriend, an older brother or sister, etc.)

Emotional Abuse

Emotional abuse occurs when words or actions result in fear or a break-down of a person's self-esteem. Examples of emotional abuse are acts which:

  • terrorize
  • intimidate
  • make fun of
  • ignore
  • threaten
  • coerce
  • reject
  • harass

Coercion happens when a person uses power or authority to make you do something you don't want to do. Coercion is often used in assaults to ensure secrecy. Examples are a father who tells a child if she reveals his abuse that her mom won't love them anymore, or an abusive staff member who says he'll be fired or will take away your privileges if you don't keep silent about the abuse.

Emotional abuse, depending on how often it happens and your relationship with the person hurting you, can make you feel afraid or badly about yourself for a long time.

Active Neglect

Active neglect is deliberate lack of care so that your basic rights to shelter, clothing, food, health services or companionship are not met.

Passive Neglect

Passive neglect occurs when care in important areas (food, housing, clothing, companionship, health care) is not provided due to lack of knowledge or money, or because of illness.

While most abuse or neglect is caused by another person, some people hurt themselves. Self-abuse often occurs because of feelings of guilt, shame or worthlessness. Abuse is not the victim's fault. People who have been abused have a right to assistance. For example, people may need help to get away from the abuser or to feel better about themselves.

Consent

Consent is an important issue. Consent means that a person chooses freely and has enough information with which to make a decision. In a sexual relationship this means both people share power and control. Even if you are married or have had sex with a person before, you still have a right to choose each time whether or not to be sexual with that person.

Self-defense

Self-defense is protecting yourself by having a good attitude about yourself and your rights. You have a right to safety and respect.

Secondly, self-defense is making a decision when you are threatened or in danger. You decide what you will do and what you won't do. You may decide to keep your distance, tell the person to stop, yell or get away. You may also decide that it is safer to do nothing ã to go along with the abuse and then when you are safe to tell someone you trust and get help. All these are self-defense because you made a choice about what to do.

Reporting Abuse

Abuse is wrong and against the law. However, even where abuse is hard to prove, (for example, some emotional abuse or loss of privileges as punishment) you still have a right to report to staff of the facility or community mental health center, or to an advocate.

In April, 1985, people came before the United States Congress to talk about how they had been hurt while living in institutions. Congress recognized that people receiving mental health services risk being abused, injured and neglected, and that this was wrong. Therefore, Congress passed the Protection and Advocacy Act. In defining institutional abuse, Congress included

  • rape or sexual assault
  • hitting
  • use of more force than needed during restraint
  • use of drugs, seclusion or restraint without a clear written treatment purpose, for staff convenience or as a substitute for treatment

Ohio Reporting Law Regarding People Labeled Mentally Ill and People With Mental Retardation in Care Facilities

Ohio Revised Code (ORC), Sections 2903.33 and 2903.34

No operator or employee of a care facility shall do any of the following against a resident or patient of the facility;

  1. Commit gross abuse knowingly causing serious physical harm;
  2. Commit abuse knowingly causing physical harm or recklessly causing serious physical harm by physical contact, or the inappropriate use of a physical or chemical restraint, medication, or isolation;
  3. Commit gross neglect knowingly failing to provide a person with what is needed to maintain health or safety when the failure results in physical harm or serious physical harm;
  4. Commit neglect recklessly failing to provide a person with what is needed to maintain health or safety when the failure results in serious physical harm to the person.

ORC Section 2903.36

A staff person who, in good faith, reports abuse cannot be discharged or discriminated against.

ORC Section 109.86

The Attorney General must investigate reported abuse in residential facilities.

Non-Reporting

Until recently, various forms of violence have been considered private, secret events. Today, women and men are talking about their experiences of incest or child abuse, women are talking about rape and battery, people receiving services are speaking out against abuse in institutions and other aspects of services. People who have been abused are seeing they are not alone and not to blame for the abuse.

Reporting rates, however, remain low. This is true because there are many more reasons to keep silent than there are rewards for reporting. What follows is a list of reasons why people might not report when they have been abused or seen another person's abuse.

People may not report because they

  • fear punishment (increased medication, move to more restrictive ward, loss of privileges, etc.);
  • fear that no one will believe them or have already experienced not being believed;
  • fear or have experienced staff labeling their report as manipulative, delusional or a symptom of illness;
  • fear further or more severe abuse;
  • fear that alternatives to the present abusive situation may be worse than living with the abuse;
  • feel guilty or believe the abuse was their fault;
  • feel emotionally or financially dependent on the victimizer;
  • feel embarrassed, especially in cases of sexual assault;
  • love or care about the abuser, and don't want him/her to go to jail or lose a job;
  • don't know that the abuse is a crime and/or a violation of rights;
  • believe that the abuse is a private event and should not be reported.

There are also special issues for men. People in our society believe that men should be strong, powerful and in control all the time. Disclosing abuse, especially sexual assault, may feel embarrassing or humiliating. It is not possible to be in control all the time. You have a right to report abuse.

There are many other reasons why people don't report. Talk with others and think about other reasons. Families, communities and residential facilities will be safer when abuse becomes a public issue, the safety of people who report is ensured, and abusers are held responsible. Peer support groups for people who have been abused can also be a good tool for getting support and a sense of control that was stripped away because of the abuse.

Because abuse experiences can be emotionally very painful, after you begin to talk about them you may experience things you have not thought or felt before. This can be frightening. You have a right to support and assistance and a right to advocate for what you need.

Resources

Law Enforcement

In the community, contact local police or sheriff's departments to report criminal acts such as domestic violence, robbery or sexual abuse. Some police departments have sexual assault squads to meet the special needs of rape victims.

If you are physically or sexually abused in an institution, and report to someone in the institution, hospital staff will investigate and will also call the state highway police. State institutions will also call Security (the institution police) when someone is abused. You have a right to press charges if you are assaulted while staying in an institution.

City or County Prosecuting Attorney

You can file charges in the prosecutor's office. It is best to call first to find out office hours. If you give a brief description of the abuse the prosecutor's office can direct you to the proper address for filing charges. Larger communities may have separate offices for filing rape charges (a felony) and domestic violence charges (usually a misdemeanor).

You can also ask the prosecutor's office if they have a Witness Assistance Program. Program staff offer help with filing charges, mediation hearings, community and legal referrals, support or other information.

In cases of domestic violence, a civil temporary protection order (CPO) can be issued by the court whether or not charges have been filed. A hearing will be held to see if there is reason to issue an order. Purposes of the CPO can include ordering the abuser to:

  • stop the violence
  • stay away from home or where you work
  • continue financial support
  • go to counseling for his battering problem

A CPO can also give temporary custody of children. It can be issued for one year and renewed if necessary. In some counties, it is hard to get a CPO without a lawyer. Call Legal Aid (see below) for help or a referral.

A criminal temporary protection order (TPO) can be issued during a hearing if charges are filed, and is good only until your domestic violence case is heard or the case is ended in some way. If you are a victim of a violent crime you may be eligible to receive money from the Ohio Victims of Crime Program for your loss or to pay your bills or other expenses. To be eligible you must have reported the crime to police within 72 hours, although there may be exceptions to this. Call the Victim's Hotline Number: 1-800-824-8263.

Lawyers

If you want to hire a lawyer and need help finding one, call the Ohio State Bar Association at 1-800-282-6500. You can also check to see if your city's bar association has a referral service.

You can also call your local Legal Aid service to see if you qualify for services with little or no cost. If they can't help, they'll give you other names of lawyers you can call. If you don't have the number of your local legal aid, call the Ohio State Legal Service Association at 1-800-282-3596 and they will give it to you.

In some cases, the Legal Rights Service (LRS) may be able to assist you, mainly through giving you information or referrals. For more information, see below under Advocates.

Advocates

Each psychiatric hospital has a client advocate. The advocate's job is to help you problem-solve, advocate for your rights, resolve complaints and link you with other services.

Community agencies have a Client Rights Officer whose job is similar to the hospital advocates. Usually, however, Client Rights Officers do other work in the agency besides advocacy. Because of this, they may take more time to respond, may not be able to spend a lot of time on each complaint and may have a conflict between providing services and advocating for what you want.

The Department of Mental Health has a Client Advocacy Coordinator. The department advocate can help with issues that a hospital advocate may have been unable to resolve. Advocacy can also be provided if a group of clients has an issue or complaint. Call (614) 466-2297.

You have a right to file a grievance if you have not received help at the community, institution or state level. Ask the client advocate, Client Rights Officer or a trusted staff member about how to file a grievance.

The Legal Rights Service (LRS) is an independent state agency which protects and advocates for the rights of people labeled mentally ill or developmentally disabled. LRS can advocate for you whether you are in the community or an institution. In many cases, LRS can provide advocacy services and referrals, and operates a state-wide toll-free number. Refer to Need our Help? for the hours of Intake. Call 1-800-282-9181, or for T.T.Y., call 1-800-858-3542.

The state Attorney General's Office has patient abuse investigators who look into reports of physical, sexual, emotional and financial abuse or neglect, both in facilities and in the community. Investigators work with the county prosecutor and local police. The Patient Abuse Intake Office has a toll-free number, 1-800-642-2873.

Battered Women's Shelters

These are an option for women, with or without children, who need a safe place to stay because of abuse. Shelter staff can help with housing, legal and other referrals, and provide counseling. Shelter stays are usually fairly short, from a few days to a couple months. Even if you don't need to stay at the shelter or wish to remain anonymous you can call and talk about the violence.

Rape Crisis Centers

You can call your local rape crisis center if you have been sexually abused, whether the abuse is recent or happened in the past. You can call to talk about your experiences and see what other services are provided.

If you would like a complete listing of Ohio women's shelters and rape crisis centers, the Women's Information Center will send one to you. Their number is 1-800-282-3040.

Many of the groups mentioned above will provide a speaker if you have a group of interested people.

Bill of Rights for People Receiving Mental Health Services

A person admitted to a program or facility for the purpose of receiving mental health services shall be accorded:

  1. The Right To Appropriate Treatment and related services in a setting supportive of personal liberty.
  2. The Right To An Individualized, Written, Treatment Or Service Plan, the right to treatment based on this plan, the right to periodic review and necessary revisions, and to a plan for discharge.
  3. The Right To Ongoing Participation In Service Planning and information about treatment goals and possible harmful effects of treatment.
  4. The Right To Refuse Treatment. You must give informed, voluntary, written consent to treatment, except in an emergency or if you are specifically court ordered to participate in certain types of treatment.
  5. The Right To Refuse To Participate In Experimentation. If you choose to participate you may revoke consent at any time.
  6. The Right To Freedom From Restraint Or Seclusion other than as a mode of treatment or during an emergency.
  7. The Right To A Humane Treatment Environment that affords privacy and reasonable protection from harm.
  8. The Right To Confidentiality Of Records.
  9. The Right To See Your Records. The only exceptions are:
    • Information provided by someone who has been assured this information will remain confidential; and
    • Specific material that has previously been determined, in writing, to be potentially harmful. However, such information may be made available to a health professional you choose. This person can provide you with any or all parts of this material.
  10. The Right To Talk Privately, And To Have Access To Telephone, Mail And Visitors. The only exception is if a mental health professional treating you denies access to a particular person for a specific, limited and reasonable time. This must be in writing and part of the treatment plan.
  11. The Right To Be Informed promptly of these rights.
  12. The Right To File A Grievance if your rights are not respected. Your grievance must be impartially considered within a reasonable period of time.
  13. You Have A Right To Access for the purpose of receiving assistance to understand, exercise and protect your rights.
    • The rights protection service within the program or facility, usually the Client Rights Advocate,
    • The Client Advocate in the Ohio Department Of Mental Health,
    • The Legal Rights Service (LRS), or
    • Another Qualified Advocate.
  14. The Right To Exercise These Rights Without Reprisal, including reprisal in the form of denial of appropriate, available treatment.
  15. The Right To Referral to other mental health services upon discharge.

A publication of the Legal Rights Service (LRS)
January 1993, Reviewed in 2003

This publication is protected by copyright under United States law and by international copyright laws and treaty provisions. You may copy and distribute the work provided that you use the work for personal, noncommercial use; do not add the work to a collection or use it with any other text, photographs, artwork, etc; do not modify or alter the work in any way or delete or modify any copyright; and do not publish or post all or any part of the work on any Internet site or in or on any other media without obtaining the prior written consent of Ohio Legal Rights Service.

Copyright © 1993, 2003 Ohio Legal Rights Service. All rights reserved.

The information provided in any LRS publication is not a substitute for legal advice. You should consult with a lawyer concerning your rights in a specific case. Contact your local bar association or visit the Ohio State Bar Association Web site to find a lawyer in your area.

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