Mental Health Units (Use of Force) Bill

Sarah Jones Excerpts

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

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

It is a pleasure to follow my hon. Friend the Member for Hertsmere (Oliver Dowden), and I congratulate the hon. Member for Croydon North (Mr Reed) on all his work in bringing this Bill to the Floor of the House which, as my hon. Friend the Member for Banbury (Victoria Prentis) highlighted, is an extraordinary feat. I have only been in the House for two years, but it is evident that to beat the systems of the parliamentary process and bring together so many voices to ensure that an important gap in our legislation can be addressed is really impressive, so I am delighted to speak in support of his Bill.

How we view, diagnose and treat mental health has changed dramatically over the past few years. I am delighted that our Conservative Government have taken a lead on this matter now, but we still have a long way to go. Excellent work by health professionals, the royal colleges, many excellent charities, many parliamentarians and citizens from right across society is starting to ensure that mental health is, at last, right up at the top of the Government’s and society’s priorities. Bearing in mind just how much the picture has changed in recent years, it seems somehow incomprehensible that the Mental Health Act has remained unchanged since it was enacted in 1983, which was when I started secondary school—and I am definitely not one of the younger Members in the House.

To think how policy has changed, even over the past decade, reminds us of just how an Act passed three decades ago can no longer be anywhere near fit for purpose. In some ways, it is a good thing that we have moved so far in understanding what mental health means—and, in fact, what mental ill health means. I often find it a strange use of language to talk about mental health when we mean that somebody is unwell, because it is a moment in an otherwise healthy person’s life when they are unwell. As my hon. Friend the Member for Hertsmere said, it is an invisible part of our health and ill health through, for most of us, our now fortunately very long lives.

It is great news that the Mental Health Act review is ongoing, and I look forward to continuing to work with the Government and Ministers to ensure that we get effective reform across the board. This Bill will allow us to address the use of force in mental health units, about which I have had a substantial amount of correspondence from concerned constituents and, interestingly, more widely from family and friends who often say, “I don’t want to bother you, Anne-Marie, because you are very busy in Parliament,” because this is something that really bothers people, and they have dropped me a line to highlight the fact that they want me to speak out.

[Sarah Jones (Croydon Central) (Lab)]

I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on introducing the Bill, which is important for the country and for Croydon. Seni died in Bethlem Royal Hospital, which is on the border of my constituency, and my love and support go to his family and friends for what he suffered.

A constituent came to me this week who had had a bipolar episode, ended up in a prison cell, and been assaulted. He said that “a police cell is often the first port of call for people with mental health issues, especially those unfortunate folk who, for one reason or another, end up on the streets like I had to go through.” He went to a solicitor to ask whether he should take action, and he was advised not to do so. Does the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) agree that the Bill will change practice within mental health units and will also hopefully encourage people, when things go wrong, to speak out, to take action and to feel that they will be supported in doing so?

[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.