Mental Health Units (Use of Force) Bill
Friday 6th July 2018
(6 years, 4 months ago)
Commons ChamberMental Health Units (Use of Force) Act 2018 View all Mental Health Units (Use of Force) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 15 June 2018 - (15 Jun 2018)
Sir Christopher Chope (Christchurch) (Con)
I hope that my hon. Friend the Minister will be able to give us a little more information today on her plans on the issue of the code of conduct. The advisory code is key to the Bill, and when we discussed it last time she said that she would bring draft guidance forward. I hope she will be able to tell me today whether that will be done before the Bill reaches the other place, so that there can be a proper discussion of the contents of the draft guidance at the same time as the substance of the Bill is discussed. I will give her the chance to intervene when she has the answer to that question.
In the meantime, I thank the Minister for responding to the point that I made on Report, when I asked which products were licensed by the National Institute for Health and Care Excellence for the purposes of restraint. She has now written back to say:
“there are no products in the UK which are licensed for chemical restraint as defined in the Mental Health Units (Use of Force) Bill.
However, a number of psychiatric medications can be used for rapid management of acute agitation in psychiatric patients. Of these products, Haloperidol 5mg/ml Solution for Injection is indicated for rapid control of severe acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder, when oral therapy is not appropriate.
Clinicians in the UK are primarily guided by the advice about rapid tranquilisation given in the following documents: Maudsley Prescribing Guidelines; Rapid Tranquilisation Algorithm by the Royal College of Psychiatrists; and the Rapid Tranquilisation section from Restrictive Interventions for Managing Violence and Aggression, which is published by the National Institute for Care Excellence.”
I put that on record because it is relevant to our discussion on Report, and I am grateful to her for writing to me with those details. I will give way if she has any more news about the guidance.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The guidance will be published and consulted on. Clearly, it would be inappropriate to propose guidance until Parliament has passed this legislation, but we fully undertake to consult all those with an interest. We expect that debate to take place so we can implement the Bill, if passed, within a year of its passage.
Sir Christopher Chope
I am grateful to my hon. Friend, and I hope that is the maximum timetable, rather than the minimum.
Norman Lamb (North Norfolk) (LD)
I speak briefly to confirm my very strong support for this Bill, to congratulate the hon. Member for Croydon North (Mr Reed) on pursuing it, and to pay tribute to the extraordinary stoicism of Seni’s parents, Mr and Mrs Lewis. I am not sure whether they are here today, but we owe it to them that something good comes from the tragedy of the loss of their son. When I was a Minister, I published new guidance aimed at ending the use of prone restraint—the sort of restraint used on Seni Lewis—and radically reducing the use of other restraint.
Depressingly, although it may in part be due to better reporting, the data shows very little change in the overall use of force in mental health units across the country. The truth is that force is endemic in many in-patient units. However, we also know that many units have managed to reduce the use of force substantially.
On therapeutic care and recovery, we have to confront, as a country, the use of force in our mental health units and, if we do not do that, we will never achieve the ambition of facilitating recovery for people who have experienced mental ill health. Frequently, people who find themselves in mental health units have suffered abuse in their life. For a woman who has suffered abuse, restraint, with many people holding her down to the floor, is just a repeat of that abuse. Such restraint destroys trust between staff and patient and completely undermines therapeutic care.
It is possible to achieve a much greater reduction in the use of force. This Bill, particularly through the transparency and accountability it brings, will be enormously beneficial in seeking to change that culture. I strongly support the Bill for that reason.
Philip Davies (Shipley) (Con)
I start by commending the hon. Member for Croydon North (Mr Reed) for his dedication to the Bill and, more importantly, for his dedication to his constituent Seni Lewis and his family, who have been through unimaginable tragedy.
The hon. Gentleman’s campaign to highlight the issues that the Lewis family have faced and to create a positive change in mental health practices is admirable and a true reflection of the care and compassion he applies to his role in his local community. As he knows, and as we have discussed on a number of occasions, I support the core principles of what he is aiming to do. The Bill is something of a curate’s egg, because some bits are very good, some bits are bad and, most frustratingly—this happens with virtually every Bill that comes before the House—some bits could have been much better, as he and I both agree.
As my hon. Friend the Member for Christchurch (Sir Christopher Chope) mentioned, the Minister said on Report that she could not agree to certain things being included in the Bill but that she wants them to be included in statutory guidance. I will outline my under-standing of the things that will go into statutory guidance, which the Minister will hopefully either confirm or correct. Hopefully, as I have always intended, the Bill will then be able to complete its passage in no time at all.
Clause 5, on training in appropriate use of force, is a positive step forward in the care of patients. It is an important change, as it centres on the very core of health services—the patient. Key elements of the training programme are listed in subsection (2). The use of techniques for avoiding or reducing the use of force, and the risk associated with the use of force are two fundamental points that are vital when restraint methods are part of a medical care plan.
It must not be forgotten that the most forceful restraint methods are advised to be used as a last resort. Medical staff should be fully versed in a wealth of techniques to avoid such restraints, where possible, but it must not be assumed that restraint should be banned altogether. Unfortunately, there are times when forceful restraint is necessary, but it is essential that such techniques are used with a full knowledge of the associated risks.
It is regrettable that my amendment 12, on introducing training on acute behavioural disturbance, was not accepted on Report, as it would have enhanced the Bill. I thank the hon. Member for Croydon North for supporting that amendment. I have been advised by the Minister that such training will be added to statutory guidance instead, and I thank her for sending me a letter on Wednesday to follow up on many of these points.
My concern, and I would like some clarification, is how the statutory guidance will be worded. In her letter to me, the Minister quoted the 2015 National Institute for Health and Care Excellence guidelines, which state that training on ABD
“should be included in staff training”.
The whole point of my amendment is that it would have ensured training on ABD must be included in staff training. My concern is that guidance is just that, guidance, rather than something that is mandatory. This is an opportunity to ensure the thorough education of staff on something we have established to be central to the Bill.
I therefore hope the Minister is able to confirm, whether today or in future, that training on acute behavioural disturbance must, rather than just should, be included in staff training. It must be mandatory.
Jackie Doyle-Price
I appreciate my hon. Friend’s frustration. One of the difficulties with clause 5, inevitably, is that a list of criteria could go on forever. He is right to highlight the issues of acute behavioural disturbance, which we consider already to be enshrined in guidance. I completely take his point, and I give him an assurance that we will use statutory guidance to make it very clear that staff need to be fully trained on acute behavioural disturbance, not least because, unless staff understand it, they cannot be proportionate when the use of force is, indeed, appropriate.
Philip Davies
I am very grateful to the Minister for that positive intervention, and we look forward to seeing that guidance when it is brought forward.
On clause 5, I am also supportive of the focus on involving
“patients in the planning, development and delivery of care and treatment”.
I would have preferred to see that extended to the patient’s family, as was proposed by my hon. Friend the Member for Christchurch, because, as we know, mental illness does not affect just the patient; it can affect those near and dear to them, too. Again, the Minister stated on Report that she would seek to put this into statutory guidance and I hope she intends to follow through with that, because many family members would think it is very important.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
As chair of the Westminster Commission on Autism, may I tell the hon. Gentleman that many people in the commission have a great interest in this Bill and support it? He has started off very reasonably in his remarks and I hope he will continue in that reasonable way, because the autism community want to see this Bill become law.
Philip Davies
Absolutely. The hon. Gentleman is not alone in that, and nor is the autism community—I want the Bill to become law, too. If he had not intervened on me, we could have completed this a bit sooner. I assure him that this Third Reading will complete very soon. I certainly do not intend to go on for long today and I do not think anyone else does. We want to complete this as quickly as possible and see the Bill on the statute book. I want to see that just as much as he does.
Clause 6 deals with recording the use of force and I am very supportive of having this in the Bill. It is right to record the carrying out of such practices on patients. The police have a system in place when using restraint as part of their role, so it is only right that medical staff should follow suit. I am advised by my local care trust that it does have some measures in place to record restraint of a patient, but this Bill will of course make it a legal requirement to do so, which is important and absolutely right. Again, I was disappointed that my amendment proposing that these records be added to the patient’s medical records was not accepted. As I have stated, restraint is considered to be a form of medical care and therefore should be documented in the patient’s medical notes. That would help people to know what reaction the patient had had when restraint had happened in the past. I hope the Minister will make sure that the statutory guidance can be used and updated to make sure that these things are added to people’s medical records at the same time. I hope she will be able to confirm that in the fullness of time, too.
On clause 6(5), the information listed to be included in the report is largely constructive. Where I feel it falls short is in insisting on adding what are referred to as “relevant characteristics”. As the hon. Member for Croydon North knows too well, I do not agree that that is necessary. I am of the opinion that including these “relevant characteristics” detailing race, sexuality, religion, marital status and so on is purely a politically correct gesture in order to be seen to be doing something to combat discrimination, when instead it causes the illusion of discrimination. There is a notion that this creates a more transparent mental health service, but that is not the case. For instance, the detailing of these “relevant characteristics” will extend only to the patient and not the staff. My amendment to say that staff members should be included in this was also supported by the hon. Gentleman, for which I am grateful. I hope that the Minister takes on board those points and will ensure that the statutory guidance she produces in conjunction with the Bill will set out that staff members’ “relevant characteristics” will be included alongside those of the patient.
Jackie Doyle-Price
I confirm to my hon. Friend that we will reflect on that when we come to discuss this matter with consultees. I want also to come back to the point he made earlier about families. On the face of it, we should be enshrining the rights of families in the Bill, recognising, as the hon. Member for Huddersfield (Mr Sheerman) said in regard to autism, that we often rely on families to protect individuals whose mental capacity is not enough to consent to treatment. However, we are also aware that patients suffering mental ill health can often not be best served by family members, so enshrining this in the Bill and in law could have unintended consequences. On the role of families, we strongly feel that statutory guidance gives us a better tool with which to manage both guaranteeing their rights and protecting individuals who might be vulnerable to their family under the law.
Philip Davies
Again, I am very grateful to the Minister for that and for her positive approach to ensuring that the points being raised here and that we raised on Report will be considered for the statutory guidance. We will therefore look forward to seeing it when it is published.
Finally, I wish to refer to clause 12, which deals with video recording and specifically details the police use of body-worn cameras when assisting in restraint at a mental health unit. Largely, police body cameras are used in this instance, unless there are special circumstances. I am a big fan of body-worn cameras, which are a beneficial tool for both officers, protecting them when complaints are made about them, and the public, in making sure that the true facts of a situation are seen by everybody. However, the Bill states that the police
“must take a body camera”
and
“must wear it and keep it operating at all times”.
It goes on to state that a “failure” to “comply” makes
“the officer liable to criminal…proceedings.”
As the Minister and the hon. Member for Croydon North know, I feel that that creates a severe disproportion of consequences between the actions of the police and the actions of the medical staff.
Chris Philp (Croydon South) (Con)
Clause 12(4) states:
“A failure by a police officer to comply with the requirements…does not…make the officer”
criminally liable. I think I am right in saying that such an officer would not be criminally liable. If I have misunderstood this, I am happy to be corrected.
Philip Davies
I am grateful to my hon. Friend for that intervention. I cannot recall whether he was here on Report, but we went through this in some detail then and so I do not wish to test the patience of the House by going through it all again this morning. If he looks back at the transcript of the debate, he might not be so confident in what he said. I think there is some doubt about this provision and it offers some doubt for police officers, who have also looked at the Bill. Notwithstanding that intervention by my hon. Friend, may I ask that the Minister takes this issue into careful consideration when creating the statutory guidance, if that provides an opportunity to look at this? I ask her to make sure that there are no unintended consequences. My hon. Friend the Member for Croydon South (Chris Philp) sums up exactly what is intended by the Government and the promoter of the Bill, but I hope that when the Minister brings forward her statutory guidance she will clarify the situation, because police officers are concerned about it.
Jackie Doyle-Price
Perhaps I can give my hon. Friend reassurance by saying that the College of Policing will be fully involved in the development of the statutory guidance.
Philip Davies
Again, I am extremely grateful for that and am pleased to hear it.
To conclude, I reiterate my support for the Member for Croydon North with his private Member’s Bill. As I have said on a number of occasions, I support the core principles of the Bill, although I feel that there have been some missed opportunities to achieve fully the objectives he set out. I hope that his constituents, the Lewis family, feel that the Bill is something they can proudly remember the life of Seni Lewis through, knowing that his death was not in vain. It was a terrible tragedy for the family, but it was not in vain, in the sense that they have worked very hard and constructively, and they have a fantastic Member of Parliament who has taken on board their campaign, on the back of which they have played their part in making sure that the terrible thing that happened to Seni Lewis does not happen to other families. On that basis, we should all be pleased that the Bill is passing its Third Reading today.
Catherine West (Hornsey and Wood Green) (Lab)
It is a privilege to contribute briefly to this Third Reading debate. I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on getting the Bill to this stage, and hope that there will be sufficient support for it when we vote later.
As a patron of Mind in Haringey, I know that there is a real sense of urgency regarding the need to improve the quality of services in mental health provision, not only locally but nationally. Whether it is basic primary care assistance to prevent the decline in a patient’s mental health, or at peak crisis time when psychosis, mania or the depths of the lows for a bipolar sufferer strike, it is crucial that care is provided in a professional, sensitive and compassionate manner.
Tragically, the Bill does not reflect the fatal experience of just one 23-year-old young man from my hon. Friend’s constituency: Seni Lewis died following restraint by 11 police officers while he was in a mental health unit. That was not an isolated incident. Thousands of patients have suffered abusive restraint, with too little guidance and supervision for police and mental health professionals on how best to manage mental health crisis. The high number of injuries—3,652 this year, according to the women’s charity Agenda—has been compounded by the reduction in spending on mental health wards, the cuts to training budgets for support workers, and the increased social isolation experienced by people with poor mental health. All too often, the warning signs are not picked up until a patient is very ill. Because of the lax reporting requirements on the use of restraint in the sector, it is likely that the available statistics under-report the extent of poor practice.
In a similar case highlighted by the charity Inquest, Surrey dad Terry Smith suffered at the hands of those who owed him a duty of care and he died in an ambulance, following restraint. When his behaviour became worrying, Terry’s family knew that he needed an ambulance; instead, he was met by police who, rather than seeing a vulnerable man in crisis, pursued, restrained, bound and hooded him, and then took him to a police station rather than a hospital. They only called for an ambulance when it was too late.
Seni’s law will strengthen the guidance for police and mental health professionals so that medical emergencies are recognised as such and acted on speedily. The incident occurred before the introduction of body-warn cameras. It was pleasing to hear the hon. Member for Shipley (Philip Davies) speak about best practice for body-warn cameras. When the Bill passes into law, it will assist many of our constituents, but it will disproportionately protect the high number of young women who are restrained and the high number of black and ethnic minority patients who suffer the highest number of injuries in mental health facilities.
In my first Adjournment debate, shortly after I entered the House in 2015, I highlighted the desperate need for better resourced, higher-quality mental healthcare in my constituency. This Bill will go some way towards that by bringing more clarity and better reporting standards and it will set the bar higher for police and NHS staff, as well as for mental health advocates, but most importantly it will set the bar higher for those constituents whose pain is often invisible, inexpressible, frightening and overwhelming, and who sadly so often miss out on what we all expect from health carers: clarity of purpose, clear communication, understanding and compassion.
Scott Mann (North Cornwall) (Con)
I rise to speak in support of the Bill. I congratulate the hon. Member for Croydon North (Mr Reed) on getting the Bill to this stage and his work to make sure that people who are detained in mental health units have proper rights and are properly protected. I welcome the fact that the Government support the Bill and that reforms to mental health legislation are on their agenda.
Our understanding of mental health has progressed by leaps and bounds since the Mental Health Act 1983 was introduced. We need mental health legislation that is fit for purpose in our modern times and that gives better protection to people with mental health challenges, and we need better guidance and training for those who are there to help. That is why it is right that we introduce reforms and why I will support the Bill today. Although it focuses only on a specific part of mental health provision, it will nevertheless make sure that better protections are in place.
One big issue in recent years has been the detention of people with mental health problems in police station prison cells, where they do not have the appropriate level of support which they would have access to in a mental health unit. The problem is twofold: first, there are problems with the process and resources at police stations for looking after people with mental ill health; and, secondly, there is a lack of mental health beds in many local communities. Both issues are being addressed through increases in mental health funding, with the Government pledging an additional £1 billion between 2016 and 2021.
I was pleased to hear in March that the number of people being detained in police cells in Devon and Cornwall when suffering a mental health crisis was zero, and I hope that is still the case. I look forward to seeing the numbers and hope that they are still very low. Since 2013, the figures for the number of people put in a cell alongside offenders, under section 136 of the Mental Health Act, have steadily decreased, from 800 to just 31 in 2017.
I welcome clause 2, which will ensure that mental health units have registered managers, and clauses 3 and 4, which will ensure that those managers will publish a written policy regarding the use of force on patients and that there is information explaining patients’ rights in relation to the use of force. I am particularly pleased that clause 5 will ensure that the appropriate training is in place for staff who work in mental health units. That will include making sure that staff involve patients in the planning, development and delivery of care in the unit. The risk associated with using force, its effect on a patient’s mental and physical health, and any use of force could all affect a patient’s development.
I welcome the provisions in the Bill on the use of video recording in units to make sure that any use of force is transparent and accountable. In pursuit of a more transparent system, I support clauses 8 and 9, which legislate for the publication by the Secretary of State of statistics on the use of force and an annual review of any deaths that result from the use of force. It is important that we learn from tragic incidents such as those we have heard about during our consideration of the Bill. The publication of statistics and the review of incidents will make sure that the legislation continues to work properly into the future and that patients are protected.
Once again, I welcome the Bill and the reforms that it will introduce. I wish the hon. Member for Croydon North every success in getting it through Parliament.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is a privilege to be here today. Members from all parties are often in a quandary about whether and how to be here on a Friday when we also have constituency commitments, but it was important to me that I be here today to support my hon. Friend the Member for Croydon North (Mr Reed). He has been a shining example to us all—Opposition and Government Members—of how best to use a private Member’s Bill slot, particularly as a member of the Opposition. He has put forward a change to the law in a way that has essentially secured support from Members on both sides of the House, as we have heard from the speeches so far. He has not only carried Members with him but achieved the Government’s support. I do not want to jinx anything, but I anticipate and hope that, at the end of today’s deliberations, the Bill will progress to the other place.
It has been a privilege for me to play a small part in the process, having served on the Bill Committee. I also stand here on behalf of the Labour Campaign for Mental Health. Many people outside this place are following our discussions today and have followed what has happened to get to this point. People with lived experience, family members and clinical professionals are really pleased that we are working on something that is productive and positive. I believe, as does my hon. Friend the Member for Croydon North, that it will effect some change in our country.
I do not seek to speak for long, but wish to reflect on a few reasons why the Bill is so important. I hope that we will be joined by Mr and Mrs Lewis—I know that they are on their way—because it is a testament to them and to their courage and bravery that they have worked to ensure that, in the wake of the tragedy that they have experienced, some good will come from the tragic death of their son. Members from all parties have come together today to reflect on Seni’s death.
But it is not just Seni’s death; in fact, only this week we heard about some research done by the UK-based charity Agenda, which campaigns for women and girls at risk. That research shows that over the past five years, from 2012-13 to 2016-17, 32 women who were detained under the Mental Health Act died after experiencing restraint. That is another example of why the issues we are discussing are so important. Those 32 women lost their lives as a result of what happened to them in mental health units.
If we look a little more closely at the figures, we see that younger women made up the majority of those restraint-related deaths, and more than a fifth of them were from black, Asian and minority ethnic backgrounds. I listened very closely to the hon. Member for Shipley (Philip Davies), but I do think that it is important, in the context of what we are discussing today, to look very closely at defined and protected characteristics. We are seeing certain groups disproportionately affected by this action in more ways than others.
Many programmes have shone a spotlight on what happens inside some of our mental health services, in particular, the Dispatches programme “Inside The Priory”, which was shown on Channel 4 back in February. It had to use undercover cameras to expose what happened in one unit alone. It was particularly disturbing, because it showed the high-stress environments that exist in some, but certainly not all, of our mental health in-patient units. I have had the privilege of visiting a number across the country. However, when people find themselves in a crisis in such an environment, all too often, unfortunately, the staff are temporary, or they are bank staff or agency staff. To echo what others have said today, the fact that we have a recruitment crisis in this sector will have an impact on someone’s recovery. We should be doing everything possible to ensure that those environments are therapeutic and that they lead to someone’s recovery. I see this as something that is absolutely critical, but is it not a shame that we are discussing it today, and that we have to make this law? Actually, we should be doing everything possible to prevent people from getting into in-patient units in the first place, but if they are there, the settings should be right, the staff should be trained and full-time and the environment should be therapeutic. The fact that that is not the case is why this law is even more crucial.
We need to do everything possible to eradicate restrictive practices in in-patient care. This law is crucial in ensuring that when these things happen, everything possible is done to protect patients, to ensure that they are given a voice, and to ensure that they are not held or treated in a way that will exacerbate the very condition that saw them go into a mental health in-patient unit in the first place. Once again, I echo my thanks to my hon. Friend the Member for Croydon North for all the work that he has done to get us to where we are today.
Mary Robinson (Cheadle) (Con)
It is a pleasure to follow the hon. Member for Liverpool, Wavertree (Luciana Berger). I too add my congratulations to the hon. Member for Croydon North (Mr Reed) on introducing this Bill and on his tireless efforts to guide this important piece of legislation through the House. I was here last month, when this Bill was last discussed, but unfortunately I did not get an opportunity to contribute, so I am very pleased to be able to speak in support of it today.
This is a sensible Bill. It follows recent announcements by the Prime Minister and Ministers addressing mental health, and feeds into current initiatives on how best to improve current systems of support for people who face mental health problems. The figures on mental health are striking: every week, one in six adults suffers from some sort of mental health condition, such as anxiety, depression and suicide. Even more alarmingly, one in five has considered taking their own life at some point.
I am encouraged to see that the Government are taking the issue of mental health so seriously and as seriously as physical health. In my view, parity of esteem means far more than simply saying we value a person’s mental wellbeing. It must mean tackling mental health issues with the same energy and priority with which we tackle physical illness. It is about changing the experience for people who require help with mental health problems. In addition, we must aim to put the funding and training for mental health services on a par with those for physical health services.
Crucially, we must end what appears to be the criminalisation of mental health conditions. The tragic case of Olaseni Lewis highlighted for many how quickly the police can become involved in mental health situations in a way that they perhaps do not in physical heath cases. Indeed, the Metropolitan police force received a phone call relating to mental health every five minutes last year, an escalating level of demand which they have said could be caused by NHS services struggling to cope. The number of calls handled by the Metropolitan police in which someone was concerned about mental health hit a record 115,000 in the past year—on average 315 a day, or about 13 an hour.
In some cases, ill people struggling to find help have even committed crimes to obtain treatment, believing that that was the best way to get access to mental health services. The Met also expects to use powers to detain under section 136 of the Mental Health Act 1983 more often. Data from health partners in my own area of Greater Manchester indicate that around 1,000 people each year are detained under section 136.
However, some really good initiatives are being rolled out. I wish to highlight an initiative from my own force in Greater Manchester. It has collaborated with Greater Manchester West Mental Health NHS Foundation Trust to provide a training programme for staff that improves the understanding of mental health. For the past 12 months, staff and officers at Greater Manchester police have received comprehensive mental health training, delivered by mental health professionals. The scheme was originally designed for staff in the custody offices where people are detained, but I am delighted to report that it has proved so successful that it has now been incorporated in the training requirements for response officers, police community support officers and special constables. The eventual aim is that all workers complete the sessions.
The concept of parity of esteem, and indeed the wider issue of highlighting the importance of mental health, is especially vital, as we know, for young people. Some 75% of all chronic mental health problems start before the age of 18, yet currently only a quarter of children and teenagers under 15 with mental health problems get the help they need from public services. Since January 2013, there have been 17 deaths of patients under the care of young people’s mental health services. I know that the Government regard patient safety as a key priority, which is why my right hon. Friend the Secretary of State published national guidance on learning from deaths last year to improve the way the NHS investigates and learns from in-patient deaths and to prevent future tragedies. I also welcome the £25 million of investment to support mental health patients so that we can achieve what we want, which is a zero suicide ambition.
I wish to speak to clause 12, which covers police-worn body cameras. That is already becoming standard practice in Greater Manchester. GMP has the largest force of officers outside London using body cameras, with more than 3,000 staff equipped with video recording devices. The Crown Prosecution Service has endorsed the equipment as a critical piece of technology not only in reducing violence, but—and this is key for this debate—in improving transparency. As the evidence suggests, there is merit in applying this measure across England and Wales. Body cameras have dramatically reduced the number of complaints made against police officers. During a trial period of their use, complaints dropped by 93%. It is because of that record that I believe body cameras will be an effective tool not only in assisting on-duty hospital staff, but in instilling those important patient safeguards.
There are good measures in the Bill which, coupled with the duties of the “responsible person”, will make this a very important piece of legislation. I am very pleased to support it and wish it well on its passage through this House.
Chris Philp (Croydon South) (Con)
Let me start by congratulating my constituency neighbour, the hon. Member for Croydon North (Mr Reed), on piloting this piece of legislation through the occasionally shark-infested waters of the private Member’s Bill process. He has done a very good job in getting the Bill to this stage. It is a particular pleasure to support it because, of course, it was the terrible suffering of a Croydon resident, one of his constituents, that inspired and motivated him to bring forward this very important piece of legislation in the first place.
This Bill, which I hope shortly will become an Act, does a very important thing in emphasising that physical force in a mental health context should be used as an absolute last resort and only after very careful thought and with great restraint, which, clearly, was not the case in the tragic death of Seni Lewis. I have been encouraged by the declining use of police custody suites as places of safety under the Mental Health Act; it has roughly halved over the past five or six years, which is a very welcome trend. I would like to see that reduced to zero.
The hon. Member for Liverpool, Wavertree (Luciana Berger) also made a very important point when she said that the use of any sort of physical force in a mental health environment is a symptom of failure. No mental health case should ever be allowed to progress to the point where physical intervention is required, although it may sometimes be unavoidable. Therefore, an emphasis on prevention, early intervention and treatment long before any physical intervention is extremely important. I am pleased that the Government are spending more money in this area. The more we can do to make sure that patients are treated well before things escalate, the better the system will be.
The Bill as amended for our consideration today is a very good Bill. I strongly support it and look forward to voting for it shortly. However, I have a couple of comments and questions that I hope the hon. Member for Croydon North and the Minister might be able to comment on and answer. My first question relates to clause 3, which is about the requirement to publish a policy on the use of force. It requires “the responsible person” to publish a policy, but as far as I can see there is no prescription as to the contours or limits imposed on that policy. For example, one might have expected to see a requirement in the Bill that any such policy limits the use of force to reasonable force. That may be done in regulations, or perhaps there was another reason it was not considered appropriate to put it in the Bill, but one might have expected some explicit statement limiting force to reasonable force. I would be interested to hear from the hon. Gentleman and the Minister why that does not appear in the Bill.
My second point relates to clause 5 on training, about which I have two questions. The first concerns subsection (2)(c) on
“showing respect for diversity in general”.
I wonder whether the hon. Gentleman could amplify a little what that means in practice. I would have expected a requirement that everyone should be treated equally, regardless of their background. Perhaps that is what he means, but I am not sure whether “showing respect for diversity” quite conveys that meaning. I would be interested to hear his and the Minister’s comments on that.
My other question relates to subsection (5) on refresher training, which it specifies should take place “at regular intervals”. I wonder whether regulations would specify what is meant by “regular intervals”. Annually would be a sensible degree of regularity, but if someone was not being true to the spirit of the Bill, they might interpret “regular” as once every 10 years, which clearly would not be frequent enough. I would be interested to hear the hon. Gentleman’s and the Minister’s views on what is suitable regularity and how that will be enforced. My view is that such training should be annually or at least once every two years.
Jackie Doyle-Price
I appreciate the spirit in which my hon. Friend is making these points. We do not want to be too prescriptive by putting in particular timings on how often the training should be, because obviously that depends very much on the context of the facility and how much wider training there is. At the same time, however, we want to be very explicit that it is regular training so that there is no excuse for staff not being properly informed about best practice in this area.
Chris Philp
I thank the Minister for her helpful intervention. Of course, I entirely sympathise with the point that Parliament should not impose unduly onerous requirements on already very busy and possibly, in some cases, overstretched mental health units, but I am concerned to make sure that we have not left a little loophole that might, perhaps inadvertently, end up being exploited so that training is not being given the degree of regularity that perhaps the House intends.
My final point of detail is on clause 6(10), which specifies the “relevant characteristics” of a patient. My hon. Friend the Member for Shipley (Philip Davies) questioned whether we need to record these “relevant characteristics”, which are listed in quite some detail. If we are going to do so, and any inference is to be drawn from those characteristics in future, it is important to measure them against the same characteristics for the whole population treated in any particular mental health unit. If we are going to say, for example, that X% of people who have been subject to this procedure have a particular gender, sexual orientation, religion or ethnicity, then before drawing any inference from that, it is important to compare that statistic with the proportion of people in the unit with the same characteristic. One needs to use those statistics with of careful thought to make sure that inappropriate or inaccurate inferences do not end up being drawn.
I am, like my hon. Friend the Member for Shipley, a great supporter of the use of police body-worn cameras, which are a great innovation. They have been responsible for a huge reduction in the number of complaints against police officers, because the officer is aware that the camera is being worn and recording—that, I am sure, has some moderating influence—and the person the officer is dealing with is aware of the same thing. I am sure that that has also reduced the number of vexatious complaints against the police. It is a very welcome move.
I was not present for the lengthy debate that my hon. Friend mentioned about whether a failure to wear a body-worn camera might be considered unlawful in the light of clause 12. Personally, I draw comfort from subsection (4), which appears to say expressly that there is not criminal liability. However, I will certainly follow his advice and refer to the report of the previous proceedings on that point. In general, the use of body-worn cameras when the police are dealing with mental health cases is extremely welcome and will, I am sure, assist with the problems that have existed in this regard.
I reiterate my very warm congratulations to my constituency neighbour, the hon. Member for Croydon North, for his tireless work in this area. I am sure that not just the London Borough of Croydon but the whole House and the whole country are grateful for his work.
Jeremy Quin (Horsham) (Con)
I congratulate the hon. Member for Croydon North (Mr Reed) on this Bill, which I support. I have two concerns that I raised on Report, one of which relates to training, which was touched on by my hon. Friend the Member for Croydon South (Chris Philp). The promoter of the Bill dealt with those admirably on Report, as he has throughout the progress of the Bill, and that certainly settled my concerns.
Of course, we will have other concerns. We all know that legislating in this place is one thing, but ensuring the enforcement of that legislation is another. There are areas—social care and others—where we all have questions to ask ourselves about enforcement of stuff that gets through this House. However, I know that this Bill is sound, and it puts this country in the best place in the world for legislation on this area. I congratulate the hon. Member for Croydon North on what he has been doing. I know that he will be as doughty on ensuring that we have proper enforcement as he has been in promoting the Bill.
I echo the words of the hon. Member for Liverpool, Wavertree (Luciana Berger): this is a fantastic example of where a truly dreadful, appalling incident in an hon. Member’s constituency has provoked questions and led to an investigation, to thought, and ultimately to legislation. That is the purpose of private Members’ Bills, which, if properly scrutinised and if proper time is given, can really have a positive impact for our constituents. A dreadful incident has hopefully produced, via the work of the hon. Gentleman, a lasting legacy. I congratulate him once again on this Bill. I wish Seni’s law, as I hope it will soon become, Godspeed in its remaining stages.
Craig Tracey (North Warwickshire) (Con)
It is a pleasure to follow my hon. Friend the Member for Horsham (Jeremy Quin). I echo many of the points that have been raised by colleagues today and in the debate three weeks ago, at which I was present although unfortunately did not get the opportunity to speak.
I congratulate the hon. Member for Croydon North (Mr Reed) on the work he has done and the success he has had in gaining support not only across the House, but from Government, for this Bill, which I think we all agree is incredibly important.
I fully respect the intentions behind the Bill and the potential impact it could have for families affected by mental health. I would like to pay tribute to the hon. Gentleman’s endeavour to honour Seni Lewis’s memory in this way. I understand that Seni’s law, as the Bill is known, is personally important to the Lewis family, who have campaigned tirelessly on this issue with considerable success. These are important proposals for people in all our constituencies, and particularly those who have a family member or relative suffering with mental health issues. They need to know that the mental health units that their loved ones are in the care of are providing a safe and secure environment. That is a basic and fundamental right and expectation.
Around 9,000 people are restrained in mental health settings a year in England. The Bill is a significant piece of legislation, as it will serve as an important reform of the way in which we treat those detained under the Mental Health Act. It also represents significant progression in this area. It is about ensuring trust and accountability in the mental health system—something that tragic case studies have sadly shown is not always in place. I think every Member in the Chamber today would like to see a reduction in the use of force, and the Bill will help to provide that reduction.
However, while targets are all well and good, in certain circumstances—for example, when a patient is violent—the people caring for a patient might need to be able to protect themselves from harm and might have to resort to some form of force to do so. Assuming that use of force is a last resort, proportionate and does not risk the patient’s health, it is reasonable that they are afforded that protection. I appreciate that this is a delicate area, but it is important that clarity is provided in the published policies and that balance is sought.
I think it is fair to say that we cannot foresee every violent and threatening situation that may arise. Clearly we want a reduction in the use of force, and we can question the frequency of its use, but we must also consider a mental health carer who may find themselves attacked by a patient who may not understand what they are doing. We do not want to put people off undertaking this important role, for fear of prosecution. While these are obviously courses of action that we hope will never be needed, it is impossible to rule out situations arising in which one of them is a necessary last resort, in the best interests of both patient and carer.
Mind, the mental health charity, which does such important work in this area, makes a useful contribution to this consideration, saying:
“Healthcare staff and police do a challenging job and sometimes need to make difficult decisions very quickly. Often they use force to control someone’s behaviour, which can include physically restraining someone against their will, injecting them with medication and using seclusion to confine and isolate someone on the ward. For the person in crisis, this can be humiliating, traumatising and even life-threatening.”
A balance must be found in the interests of the wellbeing and safety of all of those involved.
The Bill complements the real focus we have seen from this Government on mental health, and in particular the treatment, priority, stigma and people costs of mental health matters. In October 2017, the Prime Minister announced that the Government would embark on a comprehensive review of the Mental Health Act, with a final report later this year. I am encouraged that the review will examine existing practices and address the disproportionately high rate of detention of people from ethnic minorities. As a country, we have taken progressive steps to improve the mental health sector, and the Bill is another step in the right direction. The Parliamentary Under-Secretary of State for Health and Social Care summed it up pretty well in Committee when she said:
“Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level.”––[Official Report, Mental Health Units (Use of Force) Public Bill Committee, 28 March 2018; c. 7.]
I wholeheartedly agree with that sentiment, so I am pleased to support the Bill today.
Mr Steve Reed (Croydon North) (Lab/Co-op)
I would like to make a few concluding remarks. I have already spoken on the Bill, so I am grateful for this opportunity but do not intend to speak at length.
Perhaps I could start by acknowledging the presence in the Chamber of Seni’s parents, Aji and Conrad Lewis—we are delighted and proud to have them here—and also Marcia Rigg, who lost her brother Sean in very similar circumstances. Although the Bill is called Seni’s law, in honour of Seni, it has affected many people beyond Seni who have lost their lives or been injured simply because they were unwell, and the purpose of the Bill is to make sure that that cannot happen again.
This week we have marked the 70th anniversary of the national health service—one of the greatest things this House has ever created. What better way to celebrate that occasion than by giving the NHS a birthday present to make it even better, creating some of the best protections anywhere in the world for people with mental ill health? That is a wonderful way to celebrate the 70th anniversary of an institution that everybody in this country is so very proud of.
My thanks go to the many people who have had a hand in the Bill, from the Minister to Members on both sides of the House, but most of all to the families who have led the campaign to get this law on the statute book. I cannot put it better than Seni’s father, Conrad, did three weeks ago, when we concluded the Report stage of the Bill. We were standing outside in the Members’ Lobby and somebody came up to Conrad and asked him, “How do you feel about today?” He said, “I bear a burden that I will have to carry for the rest of my life. It is a burden I wouldn’t wish on my worst enemy, and I don’t want any other parent to have to carry that burden.” This is our chance to make mental health services safe and equal for everyone. I am confident that the House will seize that chance, and in doing so, we will create a lasting and proud legacy for Seni Lewis.
Question put and agreed to.
Bill accordingly read the Third time and passed.