New Clause 5
Mental Health Bill [Lords]
5:45 pm
John Pugh (Shadow Minister, Health; Southport, Liberal Democrat)
I beg to move, That the clause be read a Second time.
The new clause should prompt a brief but useful debate about physical restraint and its use within the mental health service. It is about the use of seclusion, other forms of behaviour management, mechanical restraint and other interventions managing disturbed behaviour and the removal of a patient from normal levels of association and freedom—in other words, locking them away or keeping them in some very controlled environment. The new clause endeavours to specify certain purposes for which that may be done, suggesting that there should be regulations defining the circumstances in which any form of intervention might be used; reporting requirements for the use of such interventions, which obviously at times involve quite fraught methods of physical restraint; a review of such interventions, to find out how common they are; scrutiny of their use; and also a record of the circumstances under which patients subject to interventions are visited.
This is really the most troublesome of all ends of mental health care. More than 35 years ago, I think, I had my only experience of showing somebody into what was then a padded cell, in an old-fashioned, locked refractory ward. Even today I remember the episode very vividly. The individual was terribly distressed, standing out from all the other patients in many ways, and many of the patients were in a very severe state indeed. He was routinely excluded. He seemed to have some sort of immunity to drugs like Stelazine, the psychoactive then available. Therefore, he lived in a deeply troubled world, tortured by hallucinations. To this day I wonder what on earth could have happened to him.
My point is about what was done to him, however, which was not by and large therapy, but an act of therapeutic desperation. The only alternative was to over-sedate him, which is equally undesirable. Given that that is what happens in such extreme—I accept that it is quite rare—circumstances, it is entirely appropriate for us to have reports, reviews, scrutiny and a visit in order to minimise such episodes, because more sophisticated interventions might be able to prevent some cases happening. I accept that in modern medicine this procedure is rarely used and that there are alternatives. The more normal form would not be physical restraint, but some injection—forcibly delivered into the backside in all probability. Insofar as this happens at all, we need to record and regulate it as a precursor to minimising it.