Mental Health Units (Use of Force) Bill

Helen Whately Excerpts

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

[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.

[Helen Whately (Faversham and Mid Kent) (Con)]

One notable thing in the evidence about this is a huge variation in the use of restraint: in similar settings with similar groups of patients far more restraint is being used in some areas than others. Getting to the bottom of that when trying to improve the standards in all settings is surely part of the key to solving this problem.

[Mrs Trevelyan]

I thank my hon. Friend for that intervention. She is right: so often the circumstances of patients in the units has meant that people have been able to develop more sophisticated techniques and de-escalation programmes, and this best practice needs to be shared. That is the great challenge, as it so often is in education and in other parts of our public services. We need to find an effective way to share these best practices, so that we can help people who are doing their best in units across our constituencies but who are not necessarily using the most effective tools to help patients recover and restore their stability.

These two key policy areas, transparency and accountability, will protect patients, and promote dignity and respect. Everyone who passes through our mental health system should receive dignity in their care and respect for them as an individual in our society. I had a lovely chat with a gentleman on the street last night, not far from here. He was asking for money because he needed £35 for his bed and breakfast last night—this was going to be his night of luxury—and he had with him a sign saying, “This can happen to anyone.” That always makes me stop to chat. His life story was just unfortunate, with a series of unfortunate events, and there he was on the streets. Mental ill health can strike everyone, so to suggest that not everyone is entitled to that dignity would be wrong.

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[Mrs Trevelyan]

My hon. Friend is exactly right. These common-sense measures could have a dramatic impact on the way our mental health units work, and for the well-being of both staff and those who are there receiving treatment.

Another important aspect of the Bill is the proposal that justice for a potential victim would now become possible. Our country and our values are based on the rule of law, but for justice to be done we need a new and open approach which would allow our public services to learn from past mistakes and ensure that no family or individual has to suffer the tragedy of loss or injustice that has too often been experienced by patients and their families. I have a constituency case in which a young girl had been put in restraint, not within a mental health unit, but within a special school environment, and, as a result of the fits from which she suffered, she hit her head and lost her sight. That is truly tragic, and the family has fought and fought to find a way to get redress and a better educational framework for this child to learn, having developed this entirely avoidable blindness. There is a great challenge in ensuring that we have a system that is open and transparent, and that families can be heard and do not have to fight for years.

[Helen Whately]

My hon. Friend just mentioned a case in a special school. I know we are talking about mental health units, but I wish to raise in the House the concern that exists about restraint in special schools. A case in my constituency involves some autistic boys having gone through some really concerning restraint when they were quite young, which gave them serious bruising. They have now been taken out of that setting, but we have never really got to the bottom of what happened there. This feels like something that needs to be looked into.

[Mrs Trevelyan]

I would be happy to work with my hon. Friend on that. Perhaps it is something we need to look at more widely. The extraordinary staff at special schools look after children with a breadth of needs that are never the same for two days running or for any two children. We must ensure that they are empowered with the right skills and techniques to support these children, who can lead fulfilling and full lives if we can get them through the education system. As I used to say to my son—I shall namecheck him again; he hates it when I do this, but tough, it is too late—it is really difficult for a child who sits outside the norms to be in the mainstream education system, but if they can make it to adulthood, they are free to be whoever it is that God created them to be and can really flourish. The challenge for our public services, whether for those who suffer from ill health or for children in special needs schools, is not only to ensure that we have a framework that supports them and wraps them with the skills and techniques needed to help them to develop and get well, but to ensure that they are treated with the dignity that everyone would expect for a family member who was in hospital for any other physical ailment.

The proposals in the Bill are really important to me personally and profoundly important to so many of our constituents who have experienced restraint and whose families have lacked a voice on the protection of children or relatives in these situations. Indeed, many have been unable to get any form of justice or restitution for damage to their family members. Legislation can change our practices and, in turn, our attitude towards how we care for those who need it the most. I am delighted that the Bill has been introduced and give it my wholehearted support.

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[Rishi Sunak]

My hon. Friend is absolutely right and puts it better than I could myself, so I will move back to the physical world, if I may.

Sadly, the evidence is that self-harm among young people is on the rise. It is right, therefore, that the Government have responded by improving mental health training in schools. Many colleagues have already mentioned the importance of appropriate training for those dealing with children—or adults—with mental health issues. This vital training will help teachers and staff at schools not just to identify but to assist at-risk children.

[Helen Whately]

My hon. Friend is talking about mental health treatment for children and young people, where we know a huge amount of work is needed to improve services and meet rising demand, but does he welcome, as I do, the fact that last year an extra 21,000 children were treated by children and young people’s mental health services? We are making progress in this area.

[Rishi Sunak]

I thank my hon. Friend for her comment, and I know that she is a tireless advocate for healthcare services, especially mental health services, in this place. I did not know that particular statistic, but it is indeed very welcome and will be welcomed, I am sure, by hon. Members on both sides of the House.

Furthermore, it should be our aim that children are not sent out of area to be treated for general mental health conditions. Representing a large and sparsely populated rural constituency, I am particularly focused on this issue of accessibility. Right now, the local mental health trust is looking to shift in-patient services away from our excellent local hospital, the Friarage, in Northallerton, to places as far afield as Darlington, Middlesbrough and Bishop Auckland, which will mean more than an hour and a half’s drive for some patients. This is of considerable concern to me and no doubt an issue that other colleagues will have experienced themselves. Against that background, we owe it to young people to ensure that mental health services are safe and transparent, so that when young people seek help, as Seni and his family did, they will receive it, secure in the knowledge that they will receive the high standard of care we all expect.

Secondly, I turn to the action that the Government are already taking on this important topic. Legislating for parity of esteem was a landmark step in the journey to tackling the injustices faced by people suffering from mental health problems. As we all know, however, making this parity of esteem a reality in everyday life will require not just effort but determination. We cannot, however, be in any doubt about the Government’s efforts, led by a Prime Minister passionate about this issue and determined to do more than ever before to bring about real change and to tackle what has aptly been described as a burning injustice.

The Prime Minister has overseen a £1 billion increase in the funding available for mental health and, as my hon. Friend the Member for Torbay (Kevin Foster) mentioned, championed a reduction in the number of people suffering a mental health crisis who end up in a police cell rather than a place of safety in the healthcare system. The whole House eagerly anticipates the conclusion of the review led by Professor Sir Simon Wessely, who is looking at why detention rates under the Mental Health Act are increasing.

[Rishi Sunak]

The hon. Gentleman’s intervention was timely, for I was just about to say that we should examine the important, complex and sensitive issue of whether minorities are disproportionately suffering poor mental health treatment or outcomes. We should be careful, however, about reaching for the knee-jerk—and potentially mistaken—conclusion and labelling the problem as one of institutional racism.

In that regard, I hope that Sir Simon Wessely takes note of the arguments made forcefully by Munira Mirza, the former Deputy Mayor of London, who has cited Professor Swaran Singh, a social and community psychiatrist with, I think, 30 years of clinical experience in this area, who has argued that institutional racism in his profession is not the primary cause of BME communities’ being disproportionately affected by these issues. He cites academic studies showing that BME communities and migrant groups are more exposed to mental health risk factors. We should tackle those underlying risk factors as a matter of priority. They include things such as family breakdown, substance abuse, poverty, living in areas with low social cohesion and, of course, the personal experience of migration and prior instances of racial prejudice. It is a sensitive area. The headline numbers obviously pose difficult questions for our public services, but we should get to grips with the underlying data before reaching for conclusions that may well be incorrect and that may not pay tribute to the work that people are doing with the best of intentions.

We must be more ambitious and use every opportunity available to further our efforts. Programmes such as mental awareness courses in the National Citizen Service or the £150 million that the Government are investing to support teenagers with eating disorders are practical, and will ensure that discussing mental health is not something that we do only in isolation or that happens only in a clinical setting.

[Helen Whately]

Does my hon. Friend agree that the recent announcement that 1 million people will be trained in mental health first aid is a huge step forward in raising the skills and awareness of those who help people with mental health issues?

[Rishi Sunak]

As ever, my hon. Friend makes an excellent point and displays her knowledge of this area. It is absolutely right that we bring help to people wherever they need it and in as many settings as possible. I very much welcome the extraordinary increase in the number of people being trained.

Indeed mental health provision needs to be part of an ongoing conversation about the development of young people and the issues that they face. I am confident that we as a society are now heading in the right direction. However, as I have noted, despite that substantial progress, we can in no way believe that the job is done. That is why I will now turn briefly to a few provisions in the Bill and say why they will make a real difference to the transparency in treatment of young people across the country.

The Bill will establish the requirement that mental health units must publish how and when they use force. That appears to be an eminently sensible change. All of us will be familiar with the detailed reports from Ofsted and the Care Quality Commission. The information that they publish gives us a window into how our public services are being run. Making information available about the strengths and weaknesses of organisations gives us the transparency that is needed to know what improvements need to be made. I see no reason why this should be any different with data on the use of force. This transparency is needed not just by the general public, but by the families of patients against whom force has been used. Of course, sometimes, health professionals will make the difficult judgment to use proportionate force in certain circumstances, but it took seven years for the Lewis family to get the full truth about the event that led to their son’s death. No family should be put in that position ever again.

The Bill also establishes a duty on the service provider of a mental health unit to record any instance of the use of force on a patient, in addition to recording several demographic characteristics. Added together with the requirement for police officers attending units to wear a body camera, the Bill will help us to be much clearer about how force has been used, against whom and why.

I wish to highlight the provision which says that, in the event of the death of a patient who was subject to the use of force, the Government will appoint an independent investigator who will produce a report on the incident in a timely fashion. Families who undergo such a tragic loss will have the official help that they need to get to the truth about what happened to their loved one. Those are essential changes that I hope will ensure that, in future, no family will have to fight as hard as the Lewis family did to get the truth that they deserve.

In conclusion, as many as one in four of us will experience mental ill health at some point in our lives. This is an issue that is simply too profound for us not to ask ourselves as legislators in this place, “What more can we do to prevent injustice occurring? What barriers must the House help to break down?” That is why, once again, I commend the hon. Member for Croydon North for his long-standing efforts on behalf of both the Lewis family and, more broadly, the many people across the country who suffer from mental health problems. The provisions in this Bill will give families and the public the transparency that is needed to ensure that force is used only when necessary. It is part of the journey that we are on as a nation to ensure that people with mental ill health are viewed no differently to those with physical ill health. I commend the Government for backing this vital piece of legislation, and I have been delighted to speak in favour of it today.

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[Helen Whately (Faversham and Mid Kent) (Con)]

I congratulate the hon. Member for Croydon North (Mr Reed) on introducing the Bill. I welcome the opportunity to speak on this important subject and I am pleased that the Government are supporting the Bill.

The more we speak about mental health—privately, publicly and especially here in Parliament—the more we wear away the stigma that surrounds it. As chair of the all-party group on mental health, I often speak to service users, professionals and campaigners from organisations such as Rethink Mental Illness, Mind and the Royal College of Psychiatrists. They tell me there has never been a better time to be a mental health campaigner. We have the five year forward view for mental health, a truly comprehensive and widely supported strategy to improve mental health care; a Prime Minister who is committed to fighting the injustice of inadequate treatment; and a Government who are spending record amounts on improving mental health care.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The hon. Lady has highlighted the commitment made by the Government, but does she share my concern that commitments of money that have been made are not actually reaching the frontline and there is a wealth of evidence showing that many CCGs are diverting funds intended for mental health to other parts of our NHS?

[Helen Whately]

I have enormous respect for the hon. Lady; she is doing a huge amount of work campaigning on mental health. I have looked into the question she raises about finances getting to the frontline, and 85% of CCGs are spending at the level they should be on mental health, so the majority are meeting their obligation of increasing their mental health spend. I agree that a minority are not, and they are rightly being looked at and questions are being asked about what is going on there and why they are diverting money away from mental health, but the majority are doing so. The rate of spending on mental health is going up faster than the rate of extra money going to the CCGs—so the rate of spending on mental health is increasing faster than the increase in other parts of health. That is the right thing to do, as we must improve the status of mental health in our healthcare system and achieve parity of esteem, an ambition that I know the hon. Lady shares.

All of us have been moved by the awful story of Seni Lewis, who died after being restrained face down. As we have heard, that was not an isolated case. Those awful cases are happening despite the fact that there are strong guidelines even now on the use of restraint. The Mental Health Act code of practice states that restrictive practices should be used only when there is a possibility of real harm to the patient or other people. There is also National Institute for Health and Care Excellence guidance that states that staff should be trained to avoid or minimise restrictive practices on children and young people. Despite that, instances of restraint have been going up: 17% of girls and 13% of boys admitted to child and adolescent mental health services were restrained in 2014-15. The hon. Member for Croydon North is nodding as I say that. So the use of restraint is going up and is being used when there are better alternatives.

Restraint should be a last resort. It does enormous physical and psychological damage at times to the individual being restrained, and, as others have said, there are similar implications for those applying the restraint. So the Bill is badly needed and I welcome it, in order to put in place the right systems to train staff, create proper oversight of when restraint is used, and make the system more transparent and accountable.

[Luciana Berger]

Does the hon. Lady share my concern about not only the number of times people are being restrained, but the number of times particular individuals can be restrained? In the summer, we heard the example of girl X: Sir James Munby, the most senior family court judge in our country, wrote to the Government to raise the example of this girl, who was restrained 117 times because there was not an adequate place fit for her care. Does the hon. Lady agree that that is totally inadequate—in fact, horrifying?

[Helen Whately]

That is a shocking example, and I agree that both the general issue of the use of restraint and cases when particular individuals are having to be restrained multiple times need to be looked at.

I should provide some balance and say that I recognise that there are times when restraint is necessary. That has been made clear by the people providing mental health care whom I have talked to, but it is vital that the staff who restrain are properly trained, and the provisions of clause 5 of the Bill address that. By being properly trained, they will also be able to help protect patients from trauma and injury as a result of restraint, and it will also protect staff from possible litigation when things go wrong, which would of course be bad for staff who are trying to do a good job in providing mental health care. As others have said, this is a very tough and challenging, as well as a very rewarding, sector to work in, and I, too, thank that workforce.

I have also been told that at present anyone, no matter what their background and experience is, can offer their services as a restraint trainer. It seems strange that a certain standard is not required of the trainers who train people in restraint methods. Some kind of accreditation is surely required to ensure that the training is of an appropriate standard. I find it astounding that that is not the case, and that definitely needs to be looked into.

We need to get restraint right and ensure that the use of restraint techniques follows medical evidence. I want to put on record that, while the Mental Health Act code of practice says that there should be no planned or intentional use of restraint due to the risk of restricted breathing, the Royal College of Psychiatrists has warned me that the current medical evidence does not support the use of one type of restraint over another. This is clearly an incredibly difficult area to talk about, but we need to ensure that when restraint is used, the least harmful and least dangerous methods are employed.

It is certainly true to say that the level of restraint overall is too high across the system. The level of variation that exists between mental health units indicates that there are times when restraint is not always necessary. The Care Quality Commission has published a report, “The state of care in mental health services 2014 to 2017” in which it picks up on that particular point. The report states that the CQC is

“concerned about the great variation across the country in how often staff physically restrain patients whose behaviour they find challenging. This wide variation is present even between wards that admit the same patient group.”

The fact that similar patients are being admitted but receiving different treatment in different parts of the country indicates that something is going wrong. Those who are carrying out more restraint should surely work out how they can emulate those who manage to carry out less. The CQC also noted that

“those wards where the level of restraint is low or where they have reduced it over time have staff trained in the specialised skills required to anticipate and de-escalate behaviours or situations that might lead to aggression or self-harm.”

That points to the fact that training is part of the key to reducing that worrying variation.

The Bill will introduce extra monitoring. There is often a resistance to extra monitoring because of concerns about box-ticking and form-filling, but the professionals are actually supporting it in this case. The Royal College of Psychiatrists is backing the Bill, and it recognises the need for the right regulations and for proper oversight to reduce the use of restraint in mental health units. In fact, it has gone further and signed a memorandum of understanding with the College of Policing and the Royal College of Nursing on the use of restraint in mental health and learning disability settings. So the agenda is already moving on, and the Bill is helping to focus minds on what can be done straightaway, before it even becomes law, to improve the use of restraint.

I reiterate that we need to look at the use of restraint in special schools. There was a case involving some autistic children in my constituency who were restrained in a really shocking way. No one has ever got to the bottom of what happened in that situation. I will work with my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), who has suggested that we should work together to take action on these problems as well.

As those of us who are active in campaigning on mental health will know, a major reform of the Mental Health Act 1983 is coming our way. That is very welcome and much needed. The reform will, for example, tackle the rise in sectioning and bring mental health legislation up to date. It might also have looked into the question of restraint, but it is a large piece of work. It is therefore absolutely right that, in the meantime, this Bill will take action quickly to improve the use of restraint in these difficult circumstances. Once again, I congratulate the hon. Member for Croydon North on bringing in the Bill, and I look forward to supporting it.