Mental Health Units (Use of Force) Bill

David Drew Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Mr Reed]

My right hon. Friend is absolutely right. The idea of engaging with the Welsh Assembly as the Bill proceeds through this Parliament is an excellent one, and I hope to have his support in doing so.

[Dr David Drew (Stroud) (Lab/Co-op)]

I congratulate my hon. Friend on the Bill. I declare a non-pecuniary interest in that my son is a community psychiatric nurse, although not a practising one. Does my hon. Friend agree that we need to look at the wider process of how people are taken into care? The sectioning process under the Mental Health Act 1983 does not allow any accountability to the victim. Does he agree that while the Bill is important, it needs to be seen in the wider context of how we deal with someone—at their most vulnerable—when they have been sectioned?

[Mr Reed]

I very much agree with my hon. Friend. The Government are commissioning a much wider review of mental health services. I hope it will encompass the points he raises, but that would be for the Minister to clarify.

The Bill will make sure that every mental health provider has a policy in place governing the use of force, including a clear deliverable plan for reducing its use, and ensuring that staff are properly trained in equalities and the de-escalation techniques needed to avoid the use of force. It will speed up justice and allow learning to take place by making sure that any non-natural death in a mental health unit automatically triggers an independent investigation, and making sure that recommendations from investigations and inquests are taken into account when improving mental health services in ways that currently do not happen.

The Bill is a significant step forward for our mental health services, moving them from the containment of patients to the care of patients. It will make sure that people with mental ill health are treated with compassion, not cruelty. There is overwhelming support for the Bill across the mental health sector. I am grateful for the practical support I have received from INQUEST, in particular its director Deborah Coles, and from Raju Bhatt, the widely respected solicitor who has represented so many bereaved families following deaths in custody. I am grateful to YoungMinds UK, Mind, Rethink Mental Illness, Agenda, the Labour Campaign for Mental Health, my hardworking staff and the Croydon North Ethnic Communities Forum. Also, 38 Degrees hosted an online petition that has been signed by over 60,000 people to demand this change.

--- Later in debate ---

[Mrs Trevelyan]

I thank the hon. Lady for her intervention, with which I absolutely agree. I am pleased that the number of people being held in police cells has fallen dramatically in the past few years, but, as we have seen this week, if people feel that they are suffering injustice, they should always take it to the police or, if that is where the problem or inappropriateness lies, find another outlet to be heard and to get redress. Every citizen of our country should always feel able to stand up and say, “This was wrong, and I am seeking redress for what was done to me.” I encourage the hon. Lady to support her constituent in seeking redress.

Many constituents have written to me with deep concerns about the effect that the undue use of force might have had on their child—and, in three harrowing cases, the effect that it has indeed had. One constituent detailed how the use of unreasonable restraint had a lasting effect on the health not only of the particular family member but on the whole family, which created years of trauma and ongoing illness. The use of excessive force can lead to long-term damage, and, as in the tragic case highlighted by the hon. Member for Croydon North, a death is an absolute travesty. We can never allow such abuses to take place in our civilised society.

It is good that cases of such terrible treatment are rare and that the numbers are coming down, but if we ever treat with force and brutality people who desperately need our help and support when in a state of mental ill health and distress, it is time for those voices to be heard and for action to be taken. These abuses cannot go unanswered or be tolerated any longer. The movement towards understanding mental ill health is progressing, and the Bill will help to change practice.

With that in mind, I will address two specific issues that are extremely close to my heart: autism and young people. There has previously been a lack of cross-Government co-operation on mental health issues. If we are to make a real impact on this issue and to change cultural norms, we need to ensure that the Department of Health, the Home Office, the Ministry of Justice and NHS England have closer working practices to deliver the necessary detention reforms. I hope the Minister will confirm that to the House later today.

The Bill could make a real difference in tackling the inappropriate force that is too often used against patients, many of whom are on the autism spectrum. A recent freedom of information request discovered that there were 66,681 recorded instances of restraint in England in 2015-16, an increase on the previous year. The use of physical, mechanical or face-down restraint can undermine an individual’s recovery and increase their risk of injury and long-term harm. As a society, we should be charged with protecting and helping those people to get well again.

I would hope that many in this House have read the National Autistic Society’s recent report “Transforming Care: our stories”. The report follows 13 families with a family member who is on the autistic spectrum or who has a learning disability and who is at risk of being admitted to an in-patient mental health hospital, of which there are still 2,500 across the country. One story spoke of a boy who was, according to a serious case review, “completely failed”:

“A very vulnerable young man suffered a sequence of traumatic experiences which may adversely affect him for…years.”

I am the mother of an autistic young adult—he has just turned 18—and I have other family members who are now diagnosed, and I am constantly concerned that the invisibility of autism in so many sufferers means that their mental health, or mental ill health when it hits them, has completely failed to be understood or, indeed, identified in crisis situations.

I used to have to ask teachers at my son’s school who did not understand how his Asperger’s affected him, “If he had a broken leg, would you ask him to run up the stairs or to join in a football match?” They would look a little bemused, and I would say, “He is in a state of deep stress and trauma at this point. You are expecting him to sit quietly in a classroom and pay attention, as when he is in a state of wellness. This is not possible.”

Teachers committed a huge amount of time to helping him to be in the mainstream system, and it took two or three years to understand that the invisibility not only of autism but often also of mental ill health until a crisis hits means that society cannot see it. Unless we are particularly attuned to the individual sufferer, or indeed to a wider understanding and identification of what that means, we cannot help them. It is important that people charged with looking after those who may be in need have rigorous frameworks and training. Just as we would not ask a boy with a broken leg to play in a football match, we must not have similar expectations of those in mental health crisis.

What can we say when we hear such harrowing stories, which are much more tragic than we should ever have to hear, and have to imagine the tragedy that those families have had to go through? How do we react? The instinct can no longer be to allow things to continue. We need things to improve, but we cannot just make tweaks here and there. The House cannot ignore issues that need urgent attention and reform. I am glad the Government recognise that and are supporting the Bill.

These isolated cases are sadly too common, and NHS Digital figures show that autistic young people still have an increased risk of being unnecessarily and frequently restrained because they cannot express their anxieties and crises in the way that neurotypical people more often can. We cannot continue with outdated practices and restraints that severely endanger the most vulnerable, who need considerate, appropriate and constructive treatment programmes that meet the autistic individual’s needs.

The Bill includes provisions to turn that into reality and to reform practices in mental healthcare, and it highlights a number of concepts that our constituents expect of us, of the Government and of our public services right through the system. I will cover a couple of those concepts.

First, on transparency, every time restraining force is used in a mental health unit it will be recorded and fully detailed. This would allow people to know that if this happened when they were in a state of mental ill health, it would be recorded; often people are not able to think clearly in these situations. Where someone has a broken leg or a broken arm, their mental capacities are still functioning fine and they will remember if the cast was put on the wrong arm—they would notice that. However, people in a state of deep mental ill health are not always able to see the world clearly at that point, so to have that fully detailed record will make a big difference to empowering those sufferers to know that they are being properly looked after.

In all our major institutions, such as the police or the NHS, we need accountability in everything that is done for our constituents. That is no mean feat in practice. This Bill will mean that every institution will have to have a named individual responsible for policy on the use of force and implementation. Given the discussions this week in the House, it is perhaps prescient to have a named person to whom those in distress can go, safe in the knowledge that they will be supported, understood and given a fair hearing. That is so important.

[Dr Drew]

Does the hon. Lady accept that the named individual must be able to prove that they have been trained in handling these incidents responsibly and, particularly, that they have been retrained on a regular basis? One weakness of the units is that there is not only a lack of training, but certainly a lack of updating of people’s training.

[Mrs Trevelyan]

I thank the hon. Gentleman for his intervention, and I agree absolutely that we need to get the training right in the first place; understand unconscious bias, which we all invariably suffer from, not only in general life, but within the complex environment of mental ill health; and ensure that de-escalation techniques are learned and constantly reiterated. Such an approach would allow the extraordinary people who work in this sector to be supported, constantly reminded of things and given the right tools to ensure that they can look after our family members and our constituents when they are in these crises.