I beg to move, That the Bill be now read a Second time.
Seni Lewis was a young graduate embarking on his life, aged 23, and living with his parents in Thornton Heath, when he suffered his first ever mental health episode. His parents recognised what was happening and took him to their local hospital. Seni ended up in the Bethlem Royal mental health hospital in Croydon. His parents stayed with him all day, but had to leave at 8 o’clock in the evening. Seni became very agitated when he realised they had gone, and he tried to leave, too. According to the coroner, the staff lacked the training to deal with him, and although there are no allegations that he attacked anyone, they called the police. Eleven police officers took Seni into a seclusion room and, using pain compliance techniques—the kind used against violent criminals—they took it in turns to hold him face down on the floor for 30 minutes in total. His hands were cuffed behind his back, and his legs were in restraints. They held him like that until he could no longer breathe, and he suffered a heart attack. He went into a coma, and four days later Seni was dead.
The coroner criticised Seni’s treatment as “disproportionate and unreasonable”. No patient entering a hospital for care should suffer and die in the way that Seni did. But the family’s agony did not end there. It took seven years of struggle by Seni’s grieving parents until an inquest was finally opened only this year. The coroner found severe failings by the police and the mental health services, and she gave the stark warning that
“there is a risk that future deaths will occur unless action is taken.”
That action is this Bill. What happened to Seni Lewis is not an isolated incident. According to the Independent Advisory Panel on Deaths in Custody, 46 mental health patients died following restraint between 2000 and 2014.
I am grateful to my hon. Friend for bringing forward this very important Bill. Many families in my constituency have contacted me, including some affected by autism, and they are very concerned about the kind of face-down restraint that he has described so movingly in talking about this case. Does he agree that it is very important to have boundaries on the use of this restraint, and that families have some certainty about what can and cannot happen in such facilities?
I completely agree, and I am delighted that the National Autism Society fully supports the Bill and its provisions.
I was talking about the number of patients who have died following the use of restraint, and the many more who have been seriously injured. Government guidelines say that face-down restraint is so dangerous it should not be used at all, but it was used over 9,000 times in the last year alone, including 2,500 times against children as young as seven. People who have been restrained talk about the experience with horror. They say that it is frightening, painful and humiliating, and they feel stripped of their dignity. In the words of one woman:
“It made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better.”
Statistics from the campaign group Agenda show that women are more likely to be restrained face down on the floor than men. Up to half of all women in mental health hospitals have been physically or sexually abused by men. Subjecting these women to face-down restraint by groups of men adds to the trauma that in many cases led to their mental illness in the first place.
It is difficult to understand clearly from the existing data what exactly is going on. There is no standardised way of recording why, when or how restraint is used. However, from their own data, there appear to be wide discrepancies between mental health providers. Some restrain as few as 5% of patients, while others restrain over 50%. There is no good reason for that variation.
I agree, and I very much hope that the Minister will make such a commitment today.
There are fears about unconscious bias in the mental health services. The Angiolini review, a very important review published earlier this week, notes how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody more generally. Black people are four times more likely to be sectioned than white people. If we look at the faces of the people who have died after severe restraint in a mental health hospital, we see many more young black faces than in the population as a whole. We need to understand the extent to which assumptions based on stereotypes are causing that, but to do so we need standardised data recording.
What the Bill proposes is simple, but it will make a big difference. It will standardise the way in which the data on every instance of the use of force are recorded, so that we can better understand where force is being used unnecessarily, and the extent of any bias and disproportionality in the system. It will improve arrangements between the police and mental health services, and require the police to wear body cameras when carrying out restraint, unless there are good operational reasons not to do so.
I support my hon. Friend’s Bill, particularly clause 13 on police body cameras. Is he aware that that provision applies to England only? Police body cameras are a slight anomaly in that they cannot be used by units in Wales because that matter is devolved to the Welsh Assembly. Once the Bill has been given a Second Reading, will he look at that and discuss it with the Welsh Assembly?
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.
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?
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.
More broadly, having watched documentaries on this issue, does my hon. Friend agree that there is an argument for providing the police with better training, so that they understand the difficulties facing people with mental health issues?
I absolutely agree with my hon. Friend. Unfortunately, that is outside the scope of the Bill, but I very much hope it will be in the scope of the wider review the Government are commissioning.
I am grateful to the hon. Gentleman for the time he gave me to discuss the Bill a few weeks ago. He talks about mental health professionals supporting the Bill. I have spoken to my local care trust in Bradford, which, while it supports much of what is in the Bill, has concerns about some aspects. I therefore wonder how receptive the hon. Gentleman would be to amendments, either in Committee or on Report, that try to address those concerns, or is he determined that the Bill must end up in its current form?
I thank the hon. Gentleman for his very helpful intervention. The only way to go forward with the Bill is through consensus. I have made it absolutely clear to both Ministers sitting on the Government Front Bench that I want to work with them constructively in Committee, as they have worked with me so far, so that we can secure an outcome that is supported by both sides of the House and right across the profession.
This week, the chief executives of 29 mental health organisations published a letter urging Parliament to back the Bill. It is supported by the Royal College of Nursing, the Royal College of Psychiatrists, the Care Quality Commission, NHS England and trade unions representing staff who do such an incredible job working in the mental health services. I must add my thanks to the Minister, the Under-Secretary of State for Health, Jackie Doyle-Price, for working with me so constructively; as well as my right hon. Friend Jeremy Corbyn, who supported the campaign long before he became the Leader of the Opposition.
I congratulate my hon. Friend on bringing forward the Bill. Seni Lewis was a young man who grew up in my constituency of High Peak. His cousin was telling me yesterday what a lovely young man he was, that he was never in trouble with the law, and what a loss to society he is. Does my hon. Friend agree that his family should not have had to fight for six years to get an inquest? Will he pay tribute to them for all they have done to make sure that this never happens to another family?
I absolutely agree. There is an old line that justice delayed is justice denied. No family who have lost their child in these circumstances should then have to fight the state to find out what went wrong, or to secure a modicum of justice for what happened.
Before I continue, I want to put on record my thanks also to the Prime Minister, who has met the Lewis family on more than one occasion and who I know supports the objectives of the Bill.
I have come to know Seni Lewis’s parents, Aji and Conrad, very well over the past few years. They are two of the most dignified and inspirational people I have ever met, but they have suffered pain and anguish that no parent should ever have to face. When I asked Aji and Conrad what they hoped for after all they have been through, they told me that they do not want Seni’s death to be in vain. They do not want any other family to suffer as they have suffered. I say to this House now, and to his parents, that Seni Lewis did not die in vain. We can honour his memory by making sure that no one else suffers the way he did, and by making our mental health services equal and safe for everyone. I dedicate this Bill to Seni Lewis. This is Seni’s Law. I commend it to the House.
I was going to call Mr Malthouse, but although he is on the list he is not standing up. He is showing an unaccustomed reluctance to favour the House with his views.
I thought the hon. Gentleman wanted to speak on this Bill, but if I am mistaken and he wishes to preserve his thunder then so be it. We will hear from him at a later stage.
Gosh, what a delightful choice awaits me. I call Victoria Prentis.
I am most grateful to have been called first, Mr Speaker, out of the smorgasbord of choice available to you.
It gives me genuine pleasure to rise to support the Bill and to be the first to congratulate Mr Reed on his hard work. The Bill stems from great tragedy, but it is always good to see a piece of constituency casework come to fruition and get as far as the Floor of the House. I have enormous respect for the hon. Gentleman, and the all the work he has done with people across the House and outside to get this far. I wish him all the best.
Is it not also time to pay tribute to my right hon. Friend Norman Lamb, who as Health Minister introduced the “Positive and Safe” guidelines, a two-year programme with funding to end the deliberate use of face-down restraint in all health and care settings? Unfortunately, those guidelines have not always been followed.
May I add my voice to my hon. Friend’s in congratulating the promoter of the Bill on not just bringing it to the House but gathering a consensus? Does she, like me, welcome the fact that he is willing to look at constructive suggestions in Committee to ensure the Bill is in a proper and fit state?
I thank my hon. Friend for his intervention. We have begun to understand and talk about mental health only very recently. As we do so, we learn both from those patients who have suffered tragedies and those who have had better experiences with law enforcement agencies. It is important that we learn and listen as the debate progresses. Issues may well come up in Committee that nobody has given a moment’s thought to. A constituent will have a story to tell and we can learn from it as we go forward.
From my own constituency casework, I know that for those at the point of crisis the use of restraint can be both humiliating and traumatising. I discussed this issue with the Causeway Carers, a great organisation comprising largely of parents and other family members of victims with very severe mental health problems. They meet in Bicester once a month. Many have first-hand experience of sectioning and restraint, which they shared with me. That was a great privilege and I do not feel able to share any of those stories with the House today. From what we have heard about Seni, we can all imagine the sort of stories that are taking place even on the high street in Bicester from time to time, often at night. They are also taking place in all our communities. They are not isolated stories, and none of us can feel that we are untouched by them.
These families are suffering enormously because they are dealing with a very ill family member, often a child, and restraint is added to that dreadful suffering that they already have to cope with. I recognise that the use of police cells in England as places of safety under the Mental Health Act 1983 is declining, and that more cases than ever are now referred to health-based places of safety, which is real progress. We should also welcome the significant reduction in the number of deaths in, or following, police custody since 20 years ago. I imagine that this reflects improved training, guidance and practices in a number of areas, most significantly in suicide prevention. My background is as a lawyer for the Prison Service, and it strikes me that this is in sharp contrast to the dramatic and worrying rise in suicide rates recorded in the last 20 years in prisons.
We are being consensual across the House, and I would like to retain that spirit, but would also make the point that one of the linking factors in terms of both prisons and mental health is funding for the institutions. Staff and service users at the Norfolk and Suffolk mental health trust, which is in special measures, are concerned that a reduction in the number of staff—nurses and doctors—over the past five years means they have less ability to watch and monitor patients, so it is more likely that those patients are using medication, and that means restraint is more likely to be used, so we end up with the situation that the Lewis family were in. Will the hon. Lady comment on that?
Rather than get too party political, I think it is appropriate to talk about other difficulties that have led to reductions in staffing in real terms in the Prison Service, because we on this side of the House can give lots of facts and figures about how much more is being spent. The difficulty that I know about personally now in my Banbury constituency is in recruiting and retraining staff—not with the money to pay for them, but with finding the right people. I pay tribute to all who choose to work in the very difficult mental health sphere, with patients who suffer from dreadful illnesses; the House should pay tribute to the work they do day in, day out with people who are often very difficult to deal with while they are ill.
One matter on which I am sure we can agree is the importance of reducing further the number of black, Asian and minority ethnic people detained for mental health reasons in police cells. The figures are disproportionately high. It simply cannot be right that black people are four times more likely to be detained under the 1983 Act than white people. The hon. Member for Croydon North mentioned the Angiolini review and the importance of standardised data recording. I apologise for again referring to my Prison Service experience, as the mental health system is completely different from the criminal justice system, but there are themes that run through the way BAME people are treated in both systems which we increasingly find utterly unacceptable.
I pay tribute to Mr Reed for bringing the Bill to the House. Does my hon. Friend join me in welcoming clauses 8 and 9 requiring mental health units to record the relevant characteristics of the patient on every occasion in which force is used, and to submit an annual report to the Secretary of State, so that health units and also the Secretary of State can review and understand where there are patterns of behaviour?
I could not agree more. The provision of statistics and retention of figures and then the crunching of them is vital. It might not sound exciting, but it is the only way to deal with the big problem of racial imbalance in both the mental health and the criminal justice system. It sounds absurd to say that figures are what will push through action on racial imbalances, but I truly believe that facts and figures—such as those provided recently in the report on the Prison Service, where we learned that 277 black women are in prison for every 100 white women—will help achieve that. Such figures are unacceptable on any level. The more we can talk about such figures, backed up by good evidence, the better. A civilised society cannot put up with such things.
I have strayed far from my brief. I am proud that the Government have committed to addressing the disproportionately high rates of BAME people detained for mental health reasons, and I am proud of the work the Government have done generally on mental health.
We all know that the 1983 Act is outdated, and it will be reformed to make it fit for the modern era. In October 2017, the Prime Minister announced a comprehensive review of the Act, with a planned end date for the report of autumn 2018. I am pleased that the review is being led by Professor Simon Wessely, former president of the Royal College of Psychiatrists. I worked closely with him in my previous role. We were working on a case concerning the pardoning of first world war prisoners who had been shot for cowardice, and he was able to recreate their mental health states from the limited records we had available and give invaluable evidence to the court. He is a great man and I am sure he is the right person to lead this review. He has said that he expects some of the solutions to the difficulties in the mental health system to lie in practice, leadership and culture, as well as in potential legislative change.
I have been encouraged by the work on mental health in my constituency, including in the veterans support group. It meets at Behind the Wire in Heyford Park, next to my constituency office, about once a month. It is a former military establishment and the veterans who access it feel very comfortable in that environment. It is well known that veterans as a group are more prone to experience mental health issues. This particular group offers drop-ins for veterans living in the local area so they can meet organisations including the Support, Empower, Advocate, Promote service, Help for Heroes, the Royal British Legion, Veterans UK and Rethink Mental Illness, which the hon. Member for Croydon North mentioned, and which does a great deal of good work across the country.
I have other local organisations who are doing great things in supporting my constituents, including Restore in Banbury, which I was also lucky enough to meet recently. I visited the local branch of Mind in September, which has contacted me in recent days urging me to support the Bill. Its letter said that
“the proposals in this Bill are crucial to protecting people experiencing a mental health crisis...With your support this Bill would lead to better training for staff, better data, improving transparency and highlighting problem areas”.
It therefore gives me great pleasure not only to support the hon. Member for Croydon North, but to stand up for those of my constituents who have asked me to attend this debate and to speak in it.
As a former civil servant, I cannot emphasise enough how important it is that we have a joined-up approach across Departments. It is very much not just a matter for the Department of Health; the Ministry of Justice is also involved. I speak to it frequently about mental health and prisoners and the use of restraint in the criminal justice system, and I hope that the Minister will reaffirm the importance of cross-governmental co-operation, including work with NHS England, on the delivery of reforms to detention.
Thank you very much for calling me to speak so early in the debate, Mr Speaker. I should like to begin by paying tribute to Mr Reed for bringing forward this legislation, which I very much support. In common with most Members, I am sure, I find that mental health is a rising issue in my constituency. Many of my constituents frequently contact me about it and many have particularly asked me to speak in this debate. I want to talk about two provisions in the Bill that I think are important. First, it is important to have transparency. As someone once said, sunlight is the best form of disinfectant. If people can see what is going on, they are much less likely to behave in an inappropriate fashion. The use of body cameras in many other areas of police work has done a great deal of good, so their introduction in this area, through the Bill, is to be welcomed.
Secondly, I welcome the provisions in the Bill on effective recording. One of the frustrations of my constituents who have mental health problems or whose family members have mental health problems is that the information on their interactions with public bodies—whether the police, local authorities or schools—is not properly collated or shared. Patients and their families therefore feel that they are constantly going round in circles repeating information. The more we can do to retain that information effectively, the better treatment those affected will receive. The root of all this lies in the need for a change in attitudes towards mental health; my constituency is emblematic of the changes that have taken place over the past 30 or 40 years.
Does the hon. Gentleman agree that, no matter what equipment we have, the root of the problem is not having enough staff to deal with these situations? I am a nurse, and I know that we do not have enough nurses. It is as easy as that, and we need to address the problem.
I quite agree that we need to have the right levels of staff, and that is why I am so pleased that the Government have protected police funding. I was going to come on to this point, but I will raise it now. In the health service, we are moving towards achieving parity between mental and physical health. Some of the stats on this are very welcome. We are now spending £11.6 billion a year on mental health, for example. I believe that that is more than we have ever spent before. Also, the Health and Social Care Act 2012 is giving parity of esteem.
Does my hon. Friend agree that this is not just about the numbers of staff but about how well they are trained to work in the particularly difficult circumstances of a mental health unit? The pressure on members of staff is particularly acute in such an environment. Clause 5 requires training in the appropriate use of force, which will provide positive benefits for members of staff.
My hon. Friend is absolutely right. I do not think anyone is suggesting that police officers are actively seeking to treat mental health patients in an incorrect fashion, but there is a need for training so that they understand the correct way to behave.
We on the Opposition Benches do not think that this is only about the money that is going in now. If we look at the figures, we can see that there has been an increase in recent years, but the fact is that the years of cuts that went before have had an impact on staffing levels. In my trust, the Norfolk and Suffolk mental health trust, we have seen a 20% drop in the number of doctors and nurses on the payroll in the past five years. We can train up a lower number of doctors and nurses in restraint techniques, but the fewer there are, the more risk there will be of a need to restrain. We cannot get away from that fact.
I am not sure that I entirely agree with the hon. Gentleman. Of course there have been historical problems with the funding of mental health. I hope that Opposition Members will recognise, as we do on the Government Benches, that over the decades there has not been enough funding going into that area. On the question of the NHS, however, despite this Government inheriting the largest budget deficit in our peacetime history and an appalling fiscal situation in which we were spending £4 for every £3 we earned, we made a decision to prioritise health. Health spending has risen every year under this Government and we are committed to implementing Simon Stevens’ recommendations. He, after all, was a Labour special adviser who advised this Government, and he recommended £8 billion of additional funding. I am very pleased that we have been able to do that.
When public services are stretched and under-resourced, and with rising demands, it is more important than ever that we have the correct processes in place. Our public services do an exemplary job, and the Bill is not about criticising them. It is about having a regulated, transparent process so that we can minimise harm to staff and the people they care for. I have been contacted by many of my constituents on this matter. Indeed, there is widespread public concern about it. Does the hon. Gentleman agree that we should not turn this into a debate on another issue? Please let us stick to what we are here to talk about today.
Order. I am immensely grateful to Ms Rimmer, but may I gently point out that interventions must be brief? I recognise the sincerity and seriousness of what she said, but there is huge pressure on time in respect of this Bill and of what might follow, so a certain self-denying ordinance is needed.
I thank the hon. Lady for her intervention. I know that she, like me, greatly values the work of our public sector workers. With respect, I was seeking to respond to interventions from other Opposition Members, and if they will refrain from making political interventions, I will happily refrain from rebutting them.
The root of this can be traced back to my constituency of Hertsmere, which I proudly represent and in which I was born and grew up. I remember the way in which mental health was treated during my childhood. We are on the edge of London, and London was historically surrounded by very large mental health institutions. In my own constituency, we had facilities such as the very large hospitals at Harperbury and Shenley. In many ways, those institutions had a positive ethos. I am fortunate to represent many mental health nurses who worked in those institutions and who still live in the constituency, and there was certainly a positive ethos of rehabilitation and providing a safe, calm space for people. However, the flipside of that was a tendency to put people in those institutions, shut them away and never think about the problem again. It is absolutely right that, under successive Governments, we have sought to change that approach. We now mainstream mental health problems, certainly in my own constituency and I am sure in many others.
I believe it is important for the hon. Gentleman to acknowledge that there are still far too many young people with autism and learning disability living for the long term in hospitals. Does he acknowledge that that problem is related to the resources available for their care and how those resources are spent? I believe that we need a shift towards properly resourced community settings for people with autism and learning disability, who really should not be in hospital for the long term.
The hon. Lady makes an important point. The closer to the community the treatment can be given, the better the treatment will be. I see this with my own constituents. If they are having to travel long distances, particularly with younger children, to access mental health care facilities, that can only add to the disruption in their lives. However, I believe that a journey is taking place in all of this, and I am glad that the Government are addressing the need for that journey.
The experience of many of us is that mental health is now delivered at the primary care level. From speaking to GPs in my constituency, I know that they are now on the frontline of the process. What is the answer? The first thing is to ensure that we have parity of treatment between mental and physical health. A broken limb is a serious injury and the patient is patched up and treated properly—no one doubts that they have had an injury. However, it has been the case for too long that if people have a mental health condition, it is not immediately treated with the same seriousness, and there is a sense that the person concerned has to prove that they have a problem in the first place.
My hon. Friend is making an important point. In addition to parity of esteem, we need greater understanding of what it really means to live with a mental health illness, and Bills such as this are important for raising awareness of what can be a sensitive issue.
My hon. Friend is absolutely right. This is about not just understanding the experience of the person who is suffering from mental health, but the knock-on effect on the entire family. One thing that my constituents frequently raise is the impact on other siblings when one child in the family has mental health issues and ensuring that the others do not feel neglected or disadvantaged when one sibling necessarily gets more attention.
Not only do we need to change cultural attitudes towards mental health, we need to look at the legislative framework. Most of us would agree that 1983 was the last time we had a serious, large-scale piece of legislation and, in 1983, the old model that I was discussing earlier was the prevalent model. There is a pressing need for a larger piece of legislation that can build upon on the measures in this Bill and ensure that we take a more comprehensive look at things.
I am enjoying listening to my hon. Friend’s speech. Does he agree that the use of police cells is a big area for review? While we have seen a welcome decline in the use of police cells as places of safety, it is unacceptable that someone can end up in a cell not because they are suspected of a crime, but because they have been unwell.
My hon. Friend makes an important point and that is something that we are waking up to. As Home Secretary, my right hon. Friend the Prime Minister made great strides to seek to change the approach taken by the police so that people are not automatically put in a cell. If somebody is already suffering from a mental health condition, the worst possible thing for them is a night in the cells, the conditions of which we have all seen as constituency MPs.
My hon. Friend is being extremely generous. The situation is ironic, because we have strict time limits for detention without a magistrate’s warrant due to the mental health impact on criminal suspects, yet we do not have the same for mental health. That could be looked at in future legislation.
Again, my hon. Friend makes an important and interesting intervention, which comes back to the wider question of how we achieve parity. Parity is about not just funding or treatment by GPs, but all these other forms of, for want of a better phrase, micro-discrimination.
I agree with the hon. Gentleman that parity is not necessarily achieved just through funding, but what does he think about the data collected by my hon. Friend Luciana Berger? Through FOI requests, she was able to demonstrate that half of all clinical commissioning groups are looking to reduce the amount of money they spend on mental health provision in their communities, so that they can put more money into acute pressures, with which they are struggling due to other funding arrangements.
I thank the hon. Gentleman. That goes back to my earlier point that the funding is there. We are increasing funding for the NHS, and CCGs should not be seeking to cut mental health services in order to cross-subsidise acute services. That is certainly not the case with my local CCG.
Hon. Members on both sides of the House have made important points, and I hope that the mental health review that the Government announced in the Queen’s Speech will take all considerations into account. Mental health really encompasses every area of Government activity, and a holistic approach is important.
I am conscious that I have taken up a little too much time, so my final point is about co-ordination. When sufferers of mental health find themselves in contact with the police, it is often due to more severe mental health episodes, and there is sometimes a frustration about which agency will take responsibility. If the police recognise a mental health problem, they will often get in contact with mental health services in the NHS, which may then get in contact with mental health services at the local council, and the patient and their family can feel that they are being pushed from pillar to post with no individual seeking to take responsibility. Returning to the provisions in the Bill about the collection of data, it needs not only to be collected but shared effectively among institutions. I hope that the review, which will hopefully lead to fresh legislation, will look at how to provide some co-ordination, so that there is somebody who can be a champion for people with mental health conditions and bring together the experiences of all the different institutions. At a time when families and individuals feel under so much pressure, if they can see that there is one person to whom they can relate, instead of having to negotiate with different bodies, that could provide much better outcomes.
In conclusion, I again pay tribute to the hon. Member for Croydon North for bringing this important issue to the House. I hope that this private Member’s Bill will complete its stages and make its way on to the statute book, but I also hope that it will mark the beginning of a wider process that will feed into fresh legislation covering all the different areas where we need to ensure genuine parity between mental and physical health. I hope that all hon. Members agree that that is the ultimate goal.
It is a pleasure to follow my hon. Friend Oliver Dowden, and I congratulate Mr Reed on all his work in bringing this Bill to the Floor of the House which, as my hon. Friend 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.
I congratulate my hon. Friend 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 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?
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.
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.
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.
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.
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.
My hon. Friend raises an important point. Does she agree that we must be careful not to judge people in that situation? There is always a temptation to think that there could be other reasons for it, but often they come from terrible circumstances, for example, having been the victims of child abuse and so on. There still needs to be a change in society’s attitudes, as we see when we look at some of these appalling cases of these people being abused by other members of the public.
My hon. Friend is exactly right. It is incumbent on us as we go forward with this Bill to set these new markers to ensure that we get a cultural change; we need that understanding that mental ill health is part of our life experience and most of us may well suffer from it in one form or another. For those who are the most vulnerable we absolutely need to ensure that the practices are the best they can be, so that dignity and respect is afforded to every person who needs that support.
Transparency and accountability will also allow health professionals and emergency staff to manage the risks, protecting not only the patient, but our public servants. This can protect them from false allegations and allow us to have that evidence should things go wrong. Body-worn cameras are so important in this regard. The prison in my constituency, HMP Northumberland, was one of the prisons where body-worn cameras were trialled. This has been running for nearly two years now and there has been a dramatic drop not only in the reported cases of argy-bargy between prison officers and inmates, but in poor behaviour, because inmates who might have decided to have a go cannot be bothered anymore because they know it is going to be filmed; the relationship has improved so much as a result. This has created the same thing as we see where a teacher has good discipline in the classroom, understanding that if we provide a framework everyone within it works in a more conciliatory and more constructive fashion.
I am a huge supporter of body-worn cameras on police officers and on prison officers, because I believe it protects not only them, but members of the public. Does my hon. Friend agree that just as—I hope—body-worn cameras will help victims of domestic violence who perhaps do not have the confidence to give evidence against their assailants, or cannot face the consequences of doing so, the same thing may apply in respect of prisons?
My hon. Friend is absolutely right. Interestingly, even in the social media world we all live in, a storm of anonymity allows a level of poor behaviour. If the body-worn camera empowers people to remember that anything from good manners and good behaviour to constructive dialogue rather than more violent interventions is the way forward, this must be a tool we should be encouraging across the board. One hopes that behaviour can improve once people remember how these things can be done more constructively and with less violent interventions.
Does my hon. Friend also agree that one bonus of footage from body-worn cameras is that people have to go through a less lengthy investigation? Such investigations take the police officer off duty and put them on gardening leave. Having the certainty these cameras provide means that for both sides a quick resolution can be reached, and the organisation can then move on.
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.
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.
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.
I thank my hon. Friend Mr Reed for introducing the Bill; he certainly made a powerful case for it. Everything we have heard has made it clear why the Bill is necessary. I congratulate Opposition and Government Members for the constructive way in which they have contributed to the debate so far. There is broad support for the measures in the Bill and I hope that if there are disagreements, they can be ironed out in Committee.
My hon. Friend the Member for Croydon North spoke movingly about the case of Seni Lewis, who, as we heard, tragically died after being restrained face-down in a mental health hospital. We have heard other examples of the issues that the Bill is designed to address. Sadly, Seni’s case was not an isolated incident. Restraint is still used far too regularly, despite Department of Health guidelines that state it should be used only as a last resort. Guidelines state that the dangerous practice of face-down restraint should be phased out, but unfortunately the technique is still used widely. There is significant variation in the use of restraint on mental health patients.
I am not going to give way. Many other Members wish to speak and there are other items of business that we want to get to.
As Members have highlighted, there is an issue with unconscious bias. Young black men are statistically more likely to be seen as having psychosis or schizophrenia, and are at risk of being subject to inappropriate use of force, as are women.
No, I have already made the point that many Members wish to speak so I shall not be giving way.
Metropolitan police figures show that in London, 36% of the 12,605 uses of force between April and June involved black people, despite the group accounting for just 12% of London’s population. Research has shown that women, who make up 46% of patients, are subject to more than half of all incidents of face-down restraint. Women and girls’ mental health conditions are often related to experiences of violence or abuse. The use of physical restraint on a survivor of sexual or physical abuse risks re-traumatising the patient.
It is essential that we take steps to reduce the use of force and address the unconscious bias currently reported in the system. My hon. Friend’s Bill seeks to do that in four key ways: through transparency, evidence, accountability and justice. The Bill will increase transparency. Currently, data are not collected uniformly so accurate data on how often restraint is used, and on how restraint is used disproportionately against certain demographics, are hard to collate. The Bill requires a registered provider to keep a record of any physical restraint of a person at any of its mental health units. That will include the place, time and duration of the restraint, the gender, age and ethnicity of the person who has been restrained and, critically, justifications for the use of restraint. Recording in a uniform way when, how and why restraint is used, who it is used on and what steps were taken to avoid its use, will increase transparency. It will allow us to take steps to improve the system where issues of unconscious bias or the overuse of restraint occur.
The Bill introduces steps to build and improve the evidence available when force or restraint are used. Currently, many forces require officers to wear operational body cameras, but not all. The Bill will require all police officers to wear such a camera when they are called to a mental health unit for any reason, unless there are clear operational reasons for not doing so. Research carried out at the University of Cambridge found that the use of police body-worn cameras made the use of force 50% less likely. Furthermore, the research found that the number of complaints filed against officers reduced tenfold. The evidence shows us that body-worn cameras work. They increase public trust in the police and protect our police officers from spurious complaints. The Bill would therefore improve overall accountability.
The Bill creates two further duties: it requires the responsible person to make and maintain a written policy for the use of physical restraint and take steps to ensure that physical restraint is used only in compliance with that policy, and it requires training to be provided to all frontline staff.
The Bill also seeks to improve access to justice. We want to ensure that tragedies such as those we have heard about today do not happen again. The bulk of the Bill works towards that goal. When tragedies such as what happened to Seni occur, we need to make sure that they are properly investigated and that the families of the victims receive justice. The Bill makes it compulsory for an independent investigation to be carried out whenever a death occurs in a mental health unit and the person has been physically restrained. This will end the scandal of families not knowing the circumstances of their loved one’s death.
The Bill is a step towards a model of care, rather than one of containment. Its measures will support mental health patients, their families, and emergency service workers. It will increase public trust in the emergency services and promote dignity and respect in mental health services. Restraint is used too often and disproportionately in certain sections of society. This cannot be allowed to continue. When she responds, I hope the Minister will support the Bill and allow it to be sent to Committee.
It is a privilege to be called to contribute on this important topic. Many constituents wrote to ask me to participate in this debate, so they will be delighted that I have the opportunity to highlight some of the issues they raised. I commend Mr Reed, not only for securing this debate and championing the Bill but for the constructive and consensual way he has gone about it.
So much has changed about our understanding of mental health. There was a time when we thought of mental health problems as something that happened to other people, away from ordinary life. Now, how many of us have a friend, a colleague or a family member who we know has suffered from mental ill health? That is because more people rightly no longer feel any shame about a mental health problem. Because society is on a journey of understanding, attitudes are changing and stigmas are breaking down.
We all recognise that good mental health is no less important than good physical health, but there is still so much more for us to do. The Bill is the next step in our national journey towards ending the injustices that those who experience mental health problems still face. It is for that reason that I congratulate the hon. Member for Croydon North, who has spent many years working with the family of the late Seni Lewis as they fought for the truth about what happened to their son. It is crucial that we learn the right lessons from what happened to Seni, which is why I am pleased to be able to discuss the important changes that the Bill will make to transparency in mental health units.
I wish to highlight three issues: first, I shall discuss how young people in particular are affected by mental ill health; secondly, I shall discuss some of the measures that the Government have already put in place to improve diagnosis and treatment; and lastly, I shall touch on just a few of the vital changes that the Bill will introduce.
I shall start with the topic of mental health and young people. I am passionate about helping young people to get the best possible start in life. Children and young adults should face no barrier to making the most of their unique talents and enjoying their lives to the full. Often in this Chamber, we think of the obstacles that young people may face in terms of social mobility, access to a good job or apprenticeship, or getting the right education. We are right, however, to highlight today that mental health merits no less of our attention. If we are to ensure that young people can make the most of the opportunities they have and deserve, mental health provision for them must be as accessible and high quality as possible.
The sad truth is that mental health issues disproportionately affect young people. Many of us in the Chamber are all too familiar with the negativity and hurtful comments that some people choose to spread via social media. I ask hon. Members to put themselves in the shoes of a young impressionable teenager or primary school student. One in 10 young people say they have been a victim of cyber-bullying. It is hard to imagine how difficult it might be for a young person when their smartphone or social media become ways for bullies to reach them.
I commend Google, with which I recently participated in a workshop in my constituency talking to primary school children about internet safety and how young people can protect themselves online from unwanted and hurtful attention. Google, I believe, is rolling out this project across the country, and I would urge hon. Members on both sides of the House to work with it when it comes to their constituencies, visits their schools and talks to young people about the importance of protecting themselves online.
My hon. Friend makes an excellent point. The workshops provide packs for teachers to give to children to take to their parents so that parents become much more engaged with their children’s online presence, which is something that I, as a parent of young children, am becoming more aware of, as I am sure many others in the House are. We all must be aware of what our children do online, just as we are careful when they cross the street or go to the park.
My hon. Friend is right to draw attention to the sensible measures being put in place to help potential victims, but we have to go beyond that: perpetrators of vile abuse have to understand that there will be consequences for them. The onus should not always be put on the victim: the perpetrator must expect to be punished too.
My hon. Friend makes an excellent point—and one he has spoken about before. My hon. Friend Kit Malthouse has also spoken passionately in the House about what more we need to do to protect children online and ensure they have a safe space to play and learn about the world around them.
My hon. Friend rightly pays tribute to the work of our hon. Friend the Member for North West Hampshire and makes an important point, which pertains to mental health, about children needing a safe architecture in which to grow up. Just as we, as parents, give them safety and security in the physical world, so they must have safety and security in the online world, where they spend increasingly more of their time.
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.
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.
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 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.
Moreover, of course, we should examine the important, sensitive and complex issue—
I congratulate my hon. Friend Mr Reed on bringing the Bill, which I support, to the House. I wish to make two points. First, constituents of mine, including professionals working in this field, have pointed out to me that racism causes people from black and minority ethnic backgrounds to experience mental health issues. We have heard statistics today showing that BME groups—especially black Caribbean people, who are also over-represented in hospitals and as detained patients—are more likely to be admitted to hospital. Secondly, unconscious bias among clinical professionals affects how mental health services respond to and meet the needs of people from different racial and religious backgrounds. Does the hon. Gentleman agree that it is right that the Bill will increase data and transparency on this issue?
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.
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?
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.
May I add my congratulations to Mr Reed on bringing forward this Bill? I warmly support it and applaud his willingness to work with people across the House to ensure that the Bill fully meets the concerns of Seni’s parents and family and others who have been in such circumstances—I will share another story with Members on behalf of one of my constituents shortly—and works properly for those who are involved in mental healthcare in our country and who, like our police, will occasionally have cause to restrain those who are mentally ill. Those people work in very challenging circumstances and it is important that the Bill fully reflects that and is workable and fair to them as much as it is fair and transparent for those who are on the receiving end of its provisions.
I wish to discuss three areas, the first of which is the story of my constituent, James Herbert who died in police custody in 2010. He was mentally ill and had been restrained shortly before his death. Secondly, I wish to look at how this Bill might have helped in that situation and how, in so many ways, it will certainly help to ensure that those sorts of events do not happen again. Thirdly, I will consider what additional training we might offer not only to our police, but to those who work in mental health. We need to make sure that, yes of course, there are safer techniques for restraint, but that there is also a much greater understanding of how we de-escalate those circumstances so that restraint might not be necessary.
James Herbert was known to the Avon and Somerset police, particularly those serving locally in and around Wells, as being mentally ill. Over the course of the day on which he died, there were a number of occasions when the police had had cause to observe his behaviour. On the evening after a hot June day, he was detained by the police. In the process of that detention, he was restrained. He was then put into a police van and driven for 45 minutes to a custody suite where he was stripped naked and put into a police cell. He died later that night of a cardiac arrest. The Independent Police Complaints Commission has looked in full into his death in the seven years since, and its report “Six missed chances” is rightly very critical of what happened that night. It is important to note that the police officers involved—one of whom is still a constituent of mine; the other, very sadly, took his own life a year or two ago—have not been held personally responsible for what happened. The failings that were identified were systemic, institutionalised failings—that sort of misunderstanding of mental health and the way that the processes were handled.
The Bill brings forward a very important aspect of how we deal with those with mental ill health. Sometimes, restraint is unavoidably necessary, but how that is done can have a profound impact on people such as the constituent of the hon. Member for Croydon North and my constituent, James Herbert.
Undoubtedly, the Bill will help. Staff not deliberately restraining people in a way that constrains an airway is clearly a very important and necessary provision, so, too, is restricting the intervention of a restraining technique that causes pain. Similarly, people should always seek to use the least restrictive method of restraint possible. Those are necessary de-escalatory measures, which in themselves could help, not quite to calm the person but at least not aggravate them further, which happens so often. The more that I have spoken to police officers about James Herbert’s case, the more they tell me that their concern to get their job done and retain the person means that they find themselves naturally going up through their levels of force and the application of their physical power. As both sides seemed to rub off of one another, they both got more and more aggravated, and the use of force became all the greater. The police reflected afterwards that they might have approached the situation differently in the first place.
I do not know the ethnicity of the constituent who died in custody, but does my hon. Friend agree that it can be intimidating for police and medical professionals when the person they are dealing with is physically big and robust? As well as the measures in the Bill, they need our support to ensure safety for them and for the people for whom they are caring.
My hon. Friend, as ever, makes an excellent point. These are highly challenging, confrontational situations. James Herbert was white, but he was a big guy. As his anger and emotions built, so did the efforts of the police officers who were trying to restrain him for his own safety. My hon. Friend is right to observe that there some people who require restraint are physically very intimidating. The police officers or mental health workers involved in the restraint often fear for their own physical safety, which may lead them to use overly aggressive techniques. They may really be focusing on self-preservation, instead of on de-escalation. A great confidence is required in the techniques that have been taught for restraint, and in understanding how to deal with those who have acute mental health challenges. That confidence is absolutely necessary so that people are able to apply the right skills in the right way to bring about the right outcome, instead of fearing the physical situation in which they find themselves.
I agree very much with some of the other provisions in the Bill. Seclusion should be an absolute last resort. It is an alienating and escalatory measure. Then there is the immediate, confident and sympathetic engagement of other people involved in the care of the mental health patient. When the police were detaining James Herbert, they phoned his mother to talk to her about something very different, rather than to ask her about James’s condition and what she might be able to share with them in order to manage him much more appropriately in the situation.
I agree passionately with the use of body cameras. I have seen the profound impact of James Herbert’s case not only on his own family and friends, but on the careers, lives and mental health of those involved in his detention and, sadly, his death. Body cameras would have made an enormous difference in this case.
I welcome body-worn cameras. However, when someone is subjected to immediate harm in an emergency case, the absence of a body-worn camera should not prevent someone from coming in to address the situation. Does my hon. Friend agree?
I accept that there are situations that require immediate intervention. As a former soldier who was used to working on immediate notice to move at times, I suggest that the solution is that there must always be somebody in a custody suite or a mental health ward who is wearing the right kit and is on immediate notice to move. It should be a requirement, and it should be a simple drill for those managing the facilities. That is not to say that everybody needs to be sat around at all times, wearing their stab vest and their camera. But one person in a custody suite should be required to be wearing the appropriate kit at all times. Perhaps that is something to include in the Bill. The cameras are a great addition to what police officers wear. In fact, they are a de-escalatory measure in themselves. Away from cases of people suffering with mental health issues, I have been told by the local police commander for my part of Somerset that the simple act of turning them on has such an effect. People on the high street who have had a few too many drinks see themselves on the screen and know that their behaviour is being recorded; things immediately start to calm down and responsibility returns.
I am grateful to the hon. Gentleman for raising this important point and I agree with the point made by Mrs Murray. The hon. Gentleman will be interested to know that there is a weight of published academic evidence showing that the mere presence of police wearing body cameras reduces the likelihood of force being used in these circumstances by nearly 50%. That alone is reason enough to require police to wear body cameras.
The hon. Gentleman is absolutely right. It is great on days like today when the House is in such violent agreement. The cameras really are a great addition for our police forces. They give transparency for those who want to complain about perceived unfair treatment. But they also give a protection as important as the stab vest, by reassuring police officers that they will have a video record of what they did.
I accept points from both sides of the House on body-worn cameras. The Bill makes it clear that the officer has to turn the device on as soon as practically possible from the point at which they are called. Does my hon. Friend think that it would be more practical to say that that should be at the point they attend the mental health unit, not the point at which they take the call? Is not that a little too onerous for the officers? I am just posing the question.
From discussions with local police constables and with the police commander, it seems that police officers have an instinct for when they are going into certain types of situation. One would imagine that if an officer were on the custody desk and heard that something required their intervention, they would obviously flick on their camera as a matter of drill while they were going down to the cell or wherever something was happening. That is assuming what we were just discussing—that it should be standard practice that somebody in those circumstances is always fully kitted out.
The requirement in the Bill is for officers to wear body-worn cameras when attending a mental health unit. My understanding is that that means that the unit has an issue and has called the police to attend. In many instances, custody suites have cameras, even though they may not be body-worn. The real solution is that response officers—those who are deployed ready to attend 999 calls—should have body-worn cameras. That would help not just in these instances, but in many other circumstances.
My hon. Friend is right, but whenever attending a call-out to a mental health unit—just as in attending any other event in the community—the police officer would have deployed in their patrol car wearing their full kit. They would already have been wearing the camera and would have switched on it on as they were entering the situation, if they thought that were necessary. The much more likely scenario, as perhaps would have been the case with James Herbert, is of people being called into a situation when they are not out on the street, but are just nearby and lending a hand. The fixed cameras in the building may be obscured by those doing the detention, so I also see real merit in body-worn cameras being used in those situations.
This is not just about how to ensure that acute, immediate interventions are handled properly. It is also about the additional training that might be offered to police and mental health workers to make sure that these situations do not arise in the first place. Training is key. That goes without saying for mental health workers, who, by vocation, understand this stuff very well indeed, but the police are much less confident in dealing with people with mental health issues than they should be.
Training for the police so that they can spot those signs and intervene appropriately with concern and care would be helpful and would prevent a large number of the instances that we are debating. There are techniques for reassuring people, for de-escalating, and for managing the anxiety that often manifests itself in people with mental illness. Equipping police with those skills would be very welcome indeed.
A number of years ago, when I served on the London Assembly, I visited Feltham young offenders institution. I cannot help but think that there are a number of young men in Feltham who had mental health problems but whose interactions with the police and authority during mental health episodes reached a stage at which they became violent and ultimately found themselves incarcerated, perhaps at least in part because of that lack of understanding and training on the part of the police. It is not a moral criticism but an observation that training could help the police officers and some of those young men, who were ultimately incarcerated in what was not necessarily the most appropriate institution.
I very much agree. It is interesting to reflect on conversations I have had with police and community support officers in my constituency. The nature of their job means that they understand or know more intimately the community they serve. Very often they have an insight into the mental health of people they routinely see around town who are on the edges of antisocial behaviour or even breaking the law. They can often deal with them very differently because they understand who they are dealing with. The PCSO job description is such that PCSOs naturally seek to de-escalate and deter, rather than enforce the law. My hon. Friend makes an interesting observation, and I certainly agree that it is possible to avoid these circumstances arising as often as they do.
The hon. Gentleman has pointed out the importance of PCSOs, but many police authorities are having to cut those services. Does he not agree that it is regrettable that police services have been cut and that important PCSO services have been taken away from the community?
My near neighbour, with whom I share probably the most beautiful diocese in the country, makes an interesting point, which she and I might jointly take up with the police and crime commissioner for Avon and Somerset. The decisions on how PCSOs are allocated are hers. It is not my experience in my constituency that PCSO numbers have been cut. In fact, I have been impressed by the service that we have received from PCSOs in Somerset during my time as MP for Wells. The Bill is not exclusively about the police—it is about the way in which we deal with people with mental health challenges.
It is really good that my hon. Friend has highlighted the role of PCSOs. In January, we will increase the number of PCSOs who police our communities in Kent, because we recognise that they play a key role in the transition from meeting people with mental health issues on the streets to being able to direct them to the right care at local level, rather than getting police officers directly involved at the first point. Does my hon. Friend agree that that is a good thing, and we must recognise that we are increasing numbers in some places?
I very much agree. I have no first-hand experience of policing in Kent, my hon. Friend will be pleased to know, but I certainly agree that PCSOs are important. I do not see them in any way as a poor substitute for police officers. The way in which PCSOs carry out their job is excellent. I am fortunate to have some excellent PCSOs serving towns and villages in my constituency, and they make a big difference by intervening and making sure that crime levels stay low.
We have spoken a lot about the police—inevitably so in my case, because my experience has come about as the result of a death in custody, and I wanted to share that with the House. This is really about a wider way in which we care for people with mental health conditions. Mental health is something I am passionate about, and I learned a great deal about it while serving in both Iraq and Afghanistan. Before doing so, I was very much a member of the club that said that people should just pull themselves together. The reality is that when you see people who are absolute heroes—strong, strong people—who have served in the Army for 20 years, and you see their head break, you stop making the distinction between someone having their leg blown off and someone having their head break because they have witnessed a trauma that was so profound that it did something to them and over which they had no more control that someone who has lost a limb. That led me to look keenly at what mental health provision looks like in my community.
I had quite an epiphany when I realised how important mental healthcare is. Today we are discussing how to deal with people in the moment of most acute crisis. That is a necessary discussion, but it must not distract us from the urgent need to discuss how to stop people getting to crisis point in the first place. Somerset’s mental health provision is quite hollow. We have more than adequate provision of acute mental health beds, and we have reasonable provision of community nursing, but we do not have the stuff in between: the crisis houses—the step-up, step-down facilities—that can help people to find a bit of space to avoid or see off the imminent danger of a critical episode. That could prevent their having to go to an acute facility where things might escalate even further and might stop the horrible situations we have been discussing arising.
We must also look at how we do much more upstream prevention involving mental health charities in particular. Their role is enormously important. In Wells, Heads Up, of which I am a patron, and Charley’s Memory in Burnham-on-Sea—again founded as a result of a real tragedy to do with mental health—do amazing work in our communities. They work voluntarily and charitably, but they do something that should be a really important part of a broad, deep network of mental health provision that helps to manage people through mental illness at the appropriate level and prevent their slipping into crisis as much as possible.
We must push even harder to break the taboo on mental health in our communities. If there were greater acceptance of mental health conditions and people were more willing to be open and to talk about the issue and support people with mental illnesses, fewer people would find themselves in crisis because they had become isolated and their vulnerability had become such a problem that they made a big cry for help or their illness escalated to crisis point. Parity of esteem is not just about money, although in Parliament the debate often focuses on that. It is about attitudes and acceptance too. We need a mental health system that has real depth so that we can make sure that people who are living with mental health conditions can do so with dignity, not being unnecessarily aggravated because they have unreasonable waiting times for mental healthcare, but supported by an understanding and supportive community.
Mental health workers do amazing things, and so do the police who have to work with those who are suffering from mental illness. Nothing that we are discussing today should be seen a criticism of what they do. They should understand that we understand, fully, the extraordinarily challenging circumstances in which they work day in, day out. I thank them for the extraordinary hard work that they do.
Like other hon. Members, I pay tribute to the work of Mr Reed in bringing forward this Bill. As someone who was lucky enough to get drawn in the private Members’ Bill ballot last year, I know that luck plays a part but, more importantly, so does passion. He has shown that in talking very movingly today about his constituent and what has motivated him to take forward this important Bill. I think his constituents will rightly be very proud of the work he is doing on it.
I very much welcome and support the Bill. I know from my casework and more generally that it will be welcomed in my constituency and more broadly across the country. The tone in which this debate has been conducted reflects very well on our proceedings in the House today, as does the fact that on such an important issue, hon. Members who wish to speak are having the opportunity to do so. Our constituents would expect no less. They would expect all of us who wish to speak to have the opportunity to put our views on the record about this important issue.
As the shadow Minister made clear, this Bill is about transparency and accountability. It is also about changing attitudes, and about risk. Most importantly, it is focused on making the processes involved in our treatment of those who are detained in mental health units more people-centric. As my hon. Friend
It is important that we highlight—as hon. Members have done, most recently my hon. Friend James Heappey—the debt of gratitude that we owe to all those working in the emergency services, including in the mental health setting, for the incredibly difficult job they do with an amazing degree of professionalism, compassion and care. In that context, I very much welcome clause 5, with its emphasis on the provision of training. This is about protecting and supporting not just those who are detained in mental health units, but those who may have to intervene in applying restraint. Dr Drew referred to the need for those workers not only to be trained at the induction stage but to have the training refreshed throughout their careers. That is an important point.
This Bill is about reducing the use of restraint where possible, but, as I said, it is also about risk. Too often in our society, be it in the private sector or in the public sector, there is an understandable desire to eliminate risk. The reality is that that simply cannot be done. Instead, we must seek to understand and mitigate risk, and ensure that that understanding drives the right behaviours. The data that the Bill will provide, the transparency it brings, and the understanding of how restraint operates in these settings will all feed into a better understanding of risk that will hopefully improve the way in which we treat those detained in mental health units. Of course, as the hon. Member for Croydon North made clear, this is about justice. In the tragic cases—I hope they are few in number, but they do occur—in which someone dies, it is important that the evidence exists to facilitate justice for that person and to ensure that we learn the lessons of the incident.
Finally—conscious of the importance of giving all who wish to speak the opportunity to do so, because that is what our constituents would expect—I turn to the point about changing attitudes. Attitudes to mental health in this country are changing, but there is still a long way to go. Every time we talk about mental health in this Chamber, we help to change attitudes and reduce any stigma attached to mental ill health. It is right that we continue to do so. We are on a journey, on which this welcome Bill is a hugely important step. A similar step will be the review that is under way of the Mental Health Act. The legislation may be of its time, but it is certainly not fit for our time. In that context, in addition to what we are discussing today, we must seek to create a mental healthcare system of which we can be proud, and which is fit for the 21st century. It is a pleasure to support the Bill.
The Bill is an important part of a wider issue. We need to improve our approach to mental health. Without question, mental ill health carries a stigma and a taboo, and Members from both sides have played a huge role in tackling that. One of my passions is campaigning on baby loss, which has a similar stigma and taboo attached to it. We do not talk enough about it, and that has led many people to stay silent. If we are to tackle the stigma and taboo, we have to raise these issues as much as possible and ensure that people feel able to talk about them openly. There is no greater place to do so than on the Floor of the House of Commons Chamber.
The Mental Health Act has remained unchanged since it was first published in 1983, and many consider it to be no longer fit for purpose. As a comparison, when the legislation was introduced, the Diagnostic and Statistical Manual of Mental Disorders, which is known as the DSM, existed in its third edition. Since then, it has undergone multiple revisions, and it is now in its fifth edition. The research into mental health conditions and our understanding of them have developed, particularly over the last three and a half decades, but our legislation has not changed. That is not good enough.
The Bill is one important step among many towards ensuring that people with mental health conditions are treated appropriately. I want to make it clear that there will be circumstances in which restraint is required in mental health units. That is, sadly, inevitable. Staff in such units have an incredibly challenging job. We would all agree, however, that restraint should be the last resort, not the first. I pay tribute to Mind, which launched its campaign in 2011 to reduce the use of restraint in healthcare settings. It has made fantastic progress so far.
In 2014, the coalition Government published guidance in this area following investigations into abuses at Winterbourne View hospital and a report published by Mind, which found that restrictive interventions were not being used as a last resort. The guidance made it clear that staff must use such actions only if they represent the least restrictive option for meeting the immediate need. The guidance also made it clear that staff must not deliberately restrict people in such a way as to impact on their airway, breathing or circulation. That includes face-down restraint on any surface, not just on the floor.
I continue in the spirit of the coalition Government by paying tribute, as my friend Wera Hobhouse has done—she is currently looking at her phone on the other side of the Chamber, and I cannot attract her attention—to Norman Lamb for the work that he did as a Minister. I know that this is an issue that he cares deeply about. I know that the right hon. Gentleman is not in the Chamber at the moment, but I certainly want to put that on the record—the hon. Lady still has not realised that I am complimenting her colleague—because he did a huge amount of work in this area.
Later in 2015, the Mental Health 1983 code of practice was revised, and NICE updated its guidance on violence and aggression, both of which put the emphasis on prevention and advised against the use of prone restraints. What all this recognised is that the solution is not to blame the staff, but to give them the skills and confidence to deal with some incredibly challenging situations.
In September, I visited the Lakes mental health unit in Colchester to see at first hand what a mental health unit is like. I initially had a brief meeting with senior managers, including Sally Morris, the chief executive of the Essex Partnership University NHS Foundation Trust—the names of NHS trusts always seem to be a bit of a mouthful—which manages the Lakes unit in my constituency. I was then given a tour of Ardleigh ward and Gosfield ward, and we discussed many issues. Restraint was not one of the issues we discussed, but following the debate on this extremely important Bill—the hon. Member for Croydon North, who introduced it, is now in his place—I will definitely be asking questions about the use of restraint in that unit.
I support what the Bill is seeking to achieve on training, especially as set out in clause 5(1). In many ways, it strikes me as remarkable that frontline staff would not already be given such programmes, but this is a good way of ensuring that staff, particularly new staff, are aware of best practice and guidance on the use of force. I suggest, however, that the Committee looks at whether the provision should be wider than just induction, so that existing members of staff are also given this training. In any workplace environment, it is incredibly important for people to be given refreshers to ensure that training remains fresh and at the front of their mind.
Another area I want to touch on is the mandating of body cameras for any police officer who attends a mental health unit. A number of colleagues have already raised this issue, but I want to focus on one particular area. It is important to mention from the outset that the use of body-worn cameras is ultimately a decision for local police and crime commissioners. Police forces are at different stages in this process: some are just investing now; and others are looking at new equipment, because they have used body-worn cameras for some time and are now in the second phase of procurement.
“The police officer must ensure that his or her body camera is recording…from as soon as reasonably practicable after the officer receives the request to attend the mental health unit”.
That might be looked at in Committee, because the focus should perhaps be on ensuring that there is a recording of their attending the mental health unit, rather than from the point at which they get such a request.
My hon. Friend is making some very interesting points. Does he agree that the presumption is that an officer who is on duty and using a body-worn camera should have it switched on? Only when an officer has a specific reason to turn it off—for example, when dealing with a vulnerable witness who is uncomfortable talking while the camera is on—should it be switched off.
My hon. Friend raises a very good point. I come back to what I said earlier about body-worn cameras, which is that police forces are at different stages in the evolution of these pieces of kit. Their cameras have different battery lives and different download capabilities—some recordings take several hours to download, but more modern functionality means that that can be done quite quickly—so it depends where police forces are with their procurement and how long they have had the equipment. I totally agree with him, however, that the presumption is that this piece of equipment should be on, and that is and should certainly be standard practice for newer cameras.
My hon. Friend raises a very good point. I think we are all largely in agreement about the use of body-worn cameras, and I think we all think they are an excellent evolution in policing that protects both the public and police officers. I hope the hon. Member for Croydon North does consider that carefully in Committee, working with senior police officers who use the equipment on the ground to work out how the proposed legislation should be worded to ensure it is exactly right on this point.
Essex police works in partnership with the NHS in a county-wide street triage programme that helps to provide the best possible care to people with mental health issues. This trailblazing idea works brilliantly and I will come on to mention some of the statistics relating to it. Four street triage cars, staffed by trained officers and mental health professionals from the South Essex Partnership University NHS Foundation Trust and the North Essex Partnership NHS Foundation Trust, are available to Essex police. They operate seven days a week, from between 10 am and 2 am, and are based in Harlow, Colchester, Basildon and Rochford. Officers and mental health professionals attend incidents across the county if an individual is thought to be suffering a mental health crisis and is in urgent need of support or an intervention. The person is assessed by the officers and the mental health professional, who then gets them the assistance they need if it is appropriate to do so.
The programme follows the success of a four-month pilot that ran three nights a week. During that time, 269 individuals were assessed, of whom 11 were required to be detained under the Mental Health Act 1983. Others were referred to the appropriate services and given guidance from the mental health professional who was present. This initiative has been funded by the police and crime commissioner. The scheme has proved instrumental in reducing, by nearly a quarter, the number of people across Essex detained unnecessarily by the police under section 136 of the Mental Health Act 1983. It has also ensured that those with acute vulnerability are given the care and support they need.
In summary, I very much welcome the Bill. It will ensure that staff working in mental health units are given the training that will enable them to give patients the best possible level of care; training that I believe, having met staff at The Lakes mental health unit, they want to receive. There are a couple of areas in the Bill that need tweaking—I would be very happy to work with the hon. Member for Croydon North in Committee—but nothing should stop it from being given a Second Reading. I will be supporting the Bill.
I congratulate 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.
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?
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 only be used 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. [Interruption.] 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.
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?
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 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.
I am conscious that it can sometimes be a blight on a Member’s political career to have someone from the other side of the Chamber lavish praise upon them, so I apologise in advance to Mr Reed because the opening comments of my speech could hang like a political albatross around his neck for some time. I hope he recognises, however, that even if that is the case—I suspect it will not be—the work he has done in bringing forward this private Member’s Bill will more than offset any detriment.
I suspect that when the Bill makes its way through the House and is enacted, people will look back at this as a tipping point. That is exemplified by the first few names on the list of sponsors. It is of great credit to the hon. Gentleman, both as an individual and a parliamentarian, that he is able to get support from all the parties in England and from both sides of the House. The Bill is drafted in a way that makes gaining cross-party support as easy as possible and gives it the best chance of being enacted. At a time of ultra-partisan politics around the globe and when things are proposed specifically to create division and to play games, it is refreshing to see a Bill that is clearly designed to improve and, in many instances, save lives, so I thank him for that.
The Linden Centre in Chelmsford serves my constituency, and I regularly have meetings with its management and with the Essex Partnership University NHS Foundation Trust. It is clear that the management of that mental health centre are passionate about protecting service users and improving the mental health of the people under their responsibility. I also have a close working relationship with Essex Police, whose officers are also passionate about protecting people. Before I go on, I want to echo the words of my right hon. Friend James Heappey—[Interruption.] He is not yet a right hon. Member.
It is inevitable. I echo the thanks that my hon. Friend the Member for Wells put on the record to the medical professionals, police and others who work so hard to try to protect people who have either acute or chronic mental health episodes. I would not want any of the conversation about deaths and restraint in mental health units and by police officers and others to be in any way seen as an implicit criticism of them. They do incredibly important work, often in the most difficult and challenging of circumstances.
My hon. Friend has close links with the police and with medical professionals. Do they use the same approach to restraining people? I would have thought that the police might be harder than nurses; do they use the same techniques and just apply different sections of the techniques?
I only really have detailed experience of medical and policing practices from my time on the Metropolitan Policy Authority in London and now, as the representative of Braintree, from the Essex Police and my local mental health trust, so I cannot talk about the universality of the situation. However, without a shadow of a doubt, the message that I am picking up is that there is huge variation across and within constabularies and trusts.
The group of clauses relating to accountability is one of the most significant parts of the Bill, and my hon. Friend Helen Whately touched on this. I am one of those gruff and grumpy old Tories—[Interruption.] At this point, Members are supposed to join in a chorus of “You’re not that old.”—[Hon. Members: “You’re not that old!”] I thank hon. Members, although no one cried, “You’re not that grumpy.” Clause 7 is incredibly important. I am a gruff and grumpy old Tory, and my instinct is to take away as much red tape and administrative burden as possible but, as my hon. Friend the Member for Faversham and Mid Kent highlighted, this modest additional administrative burden is welcomed by the profession.
There is an old saying in management consultancy, “If you want to change something, measure it”—[Interruption.] I can see my hon. Friend the Member for Faversham and Mid Kent nodding. It is important to register the use of force whenever it is applied, because that will do two things. It will prompt a small pause for reflection if someone knows that they will have to justify the use of force, and it is inevitably a good thing if they recognise in that moment of pause that the use of force is not appropriate. Perhaps more importantly, if the decision is made that force is the appropriate action, clause 7 will mean that there is a record of all the times that force has been used, including the times when that force does not lead to injury or, in the most tragic cases, death. That will enable us to get an accurate understanding of how many times the use of force unfortunately leads to injury or fatality, which is important because it will remind us of the difficulty faced by many professionals.
I am grateful for the hon. Gentleman’s generous comments earlier. I should make it clear that it is not my intention that the Bill should impose any additional administrative burden. Institutions already collect data on the use of force, but they do not collect it in the same way, so it cannot be compared. The Bill will simply standardise what currently happens to allow greater scrutiny, rather than imposing a new burden.
That is a fair and balanced intervention. In my next sentence—honestly, this is true—I was going to list some things that, if they are not already collected, really should be collected. It is not a bad thing if the Bill creates a standardisation so that we can see the differentials between forces and trusts.
One of the most difficult and contentious points—this goes to the heart of my opening remarks about the impact the Bill could have on British society—is that, without a shadow of a doubt, we know that examples of huge community friction, of civil disorder and of further injury and loss of life have been caused when families, friends of families and wider communities feel that the use of force has led to an unnecessary death. I will be as cautious as I can with my words because of the sensitivities, but it is particularly acute in Britain’s black communities.
There is huge disproportionality between the black community in Britain and the rest of the communities in Britain—and it cannot possibly just be chance—in the rate of death and injury in custody of people suffering mental health episodes. That has to be addressed. No single Bill can solve the situation, as it has been long in the making and will take a very long time to resolve, but this Bill could be a big step in the right direction.
If, as I suspect it will, the Bill reduces the incidence of serious injury or fatality among people suffering mental health episodes, that will in itself have a knock-on effect in reducing some of the community friction and disorder that we have seen in the past. Unfortunately, I suspect there will be further cases where a black man is detained and dies after contact with the police, but if it can be evidenced that in all instances force is applied modestly, minimally and only when absolutely necessary, that might help to defuse some of the tensions that have in the past led to further difficulties.
In conclusion, I thank the hon. Member for Croydon North, and the other hon. Members who have supported this Bill, for introducing to this place a Bill that makes it easy for those of us who want to see genuine improvement both in mental health and community cohesion to support it. I commend it to the House.
Like other hon. Members, I wish to start by congratulating Mr Reed on introducing such an important Bill. I know from my own experience two years ago of being drawn high up in the private Members’ Bill ballot that it can feel a bit of a mixed blessing. There are a few days in the lead-up to publishing the Bill when they are probably among the most popular Members of Parliament; telephone lines and email inboxes are rarely idle. Of course once the simple step of presenting the Bill is done, the really hard work begins, not only in producing the Bill and the explanatory notes, but in starting to build the consensus that allows the Bill to have a reasonable chance of progressing into legislation. The hon. Gentleman has done that exceptionally well to this point, and I know he will be proceeding as he has begun.
I also wish to thank my constituents who have contacted me, some with their own experiences and others with their own views of the current use of force in mental health units. I also thank West Midlands police and the range of organisations with an interest in mental health policy which have briefed us all, shedding new light on both the scale and nature of the problems in the system.
In recent years, mental health has come to the fore in public policy, and much of that is due to the outstanding work done by a number of right hon. and hon. Members who have a real passion for improving the way mental health is treated and ensuring that parity of esteem is not just a catchphrase but rather that it reflects the way mental health is treated, not only in the NHS, but across public policy and society more widely. In particular, I am thinking of the excellent work done by my hon. Friend James Morris, when he chaired the all-party group on mental health; by the Secretary of State for Health; and by my right hon. Friend Alistair Burt and, of course, Norman Lamb, when they were Ministers responsible for mental health.
We have seen the changes in the guidelines and the way sections 135 and 136 of the Mental Health Act 1983 are handled, and the new provisions that will be brought in through the Policing and Crime Act 2017, which gained Royal Assent earlier this year. The political consensus that there is a need to do more is being matched with real progress in both policy and legislation. All of us have welcomed the prominent place mental health reform has had, not just in the Conservative manifesto ahead of the general election, but in its being reflected in the Queen’s Speech and in the Prime Minister’s announcement that the Government would begin a comprehensive review of the Mental Health Act. Public servants who work in the police, the NHS and the justice system are often on the frontline of dealing with people with mental ill health, particularly those affected by acute episodes of mental ill health. My hon. Friend Mrs Trevelyan was, though, right to question why we always talk about mental health in terms of mental illness, because it is also important to talk about mental wellness and consider how we support, develop and improve people’s positive mental health.
A lot of the changes in the public policy framework in recent years have been driven by innovation in public services. I think in particular of the excellent work done by Inspector Michael Brown, who blogs as Mental Health Cop. He previously worked for West Midlands police, and I think he now works for the chief constable of Dyfed-Powys police. It is largely because of his work that the need to address sections 135 and 136 came to the fore of the public policy agenda. In recent decades, section 136 has set the framework within which people suffering from mental ill are treated in the police and criminal justice system. Although it is part of legislation that is nearly 35 years old, it is barely different from equivalent measures in the Mental Health Act 1959. That was 60 years ago, when there were still asylums in Britain and the whole approach to mental health was completely different. Thankfully, we no longer have asylums and we make huge efforts to treat people in the appropriate settings and in the community. We need to ensure that we adapt not only public policy but a legislative framework that was designed for a completely different society with a completely different outlook on and approach to mental healthcare. The Bill has an important part to play in changing the legislative framework.
In my area, West Midlands police have made substantial progress in how they deal with people suffering from mental illness. In July, the office of the West Midlands police and crime commissioner and the West Midlands combined authority provided an update on and summary of some of their innovations, particularly the model of mental health triage that has been operating for the past few years. A successful model for mental health triage is being rolled out across the force, throughout the Black country, Birmingham and Solihull. The model relies on an ambulance vehicle, a mental health nurse and a paramedic being available between 10 o’clock in the morning and 2 o’clock the following morning, so that when there is a call-out and it is thought there might be mental health issues to consider, there can be an appropriate health response and health assessment, alongside and as part of the police response. Shortly before I was elected to Parliament, I had the privilege of joining a triage team on a call-out in Birmingham. I saw how it worked and the difference it made compared with the old model of police officers being deployed and, more often than not, somebody suffering from a serious episode of mental ill health ending up in a police cell or another custodial setting.
Let me give an example of how the system has worked. When the police and ambulance services received a report of a 19-year-old female self-harming in the street and threatening to kill herself, a check on the mental health systems was able to establish quickly that she had an extensive history with mental health services. The paramedic had wanted to take the female to an acute hospital immediately, but the deployment of the street triage team meant not only that her wounds could be dressed by the paramedic in the car at the scene, but that the mental health nurse could carry out a face-to-face assessment and make an urgent referral to the home treatment team. As a result, she got crisis access to services overnight and then home treatment the next day, which was a much more appropriate response for somebody going through a crisis. Ultimately, she was safeguarded with a friend for the evening, who took her home and stayed with her through the night, and the whole incident lasted 45 minutes, compared with the many hours it would have taken had she gone to A&E and then other more conventional settings.
The triage teams in the west midlands have treated about 9,000 people in the last year, and as a result—despite the worrying figures we have heard from around the country—the use of section 136 powers in the west midlands has been reduced by about a third over the last five years, from typically 1,200 to 1,300 a year to 852 last year. Remarkably, in the first half of the year, nobody at all in the west midlands was detained in police custody under section 136 of the Mental Health Act—the first time this has ever happened in the west midlands. Instead, more than 8,000 people have received alternative outcomes, including referrals to a GP or other partners, to ensure they get mental health care rather than have their case treated as a purely criminal justice matter.
Although significant progress has been made, and continues to be made, the Bill will help to make further progress, especially through the way it addresses the use of force and restraint against people suffering from mental ill health. Currently, the code of practice clearly states that restrictive practices should only be used where there is a real possibility of harm, either to the patient or to someone else, and should not be used either to punish or inflict pain or suffering, and should be used with minimum interference to autonomy, privacy and dignity. In the case of children and young people, it should not be used at all. Staff should always ensure that restraint is used only after taking into account an individual’s age, size, physical vulnerability and emotional and psychological maturity.
Although the guidelines exist, further openness around the use of force and restraint is not only welcome and progressive but absolutely necessary for the individuals involved and if our public service workers are to have confidence that their actions are reasonable and defensible. That is why clause 5, which requires that registered managers have a training programme for frontline staff, is particularly important. “Frontline staff” would include all registered managers who might reasonably expect to use force or authorise its use on patients. The proposal to guarantee that staff use the latest and safest procedures should be an opportunity to build on previous learning, not only on mental health care and proportionate use, but on wider issues of equality and necessity.
Clause 6 deals with the requirement on all mental health providers systematically to record information on their use of force. As has been said, if we can measure it, we can track progress and drive changes in behaviour. Including records on the gender, age and ethnicity of patients will help to improve our understanding and, more importantly, the understanding of public services about the use of restraint, particularly on the basis of gender and race.
Let me turn now to body-worn video. Clause 13 provides that on-duty police officers who are called to a mental health unit for any reason must wear body cameras that start recording from as soon as is reasonably practicable. The west midlands, which is within my own force area, is now rolling out body cameras to all its response officers. The kind of body cameras it is using can be automatically triggered by a siren or a blue light, or if airbags are deployed and firearms are drawn. We should consider how these body cameras can be automatically deployed and, without having to think about human error, can automatically stay on until they are manually turned off.
Does it make sense that, if a police officer is on duty in a response role, the presumption should be that the camera is on? We see that in other walks of life—for example, it is the case with ticket inspectors, so it should not be that difficult to apply this practice to on-duty, on-call police officers.
My hon. Friend makes an excellent point, and he is absolutely right. We have seen body cameras used in other scenarios. They help to protect the police as well as those to whom they are responding.
I agree with everything that my hon. Friend has said, but my understanding is that, in some areas—certainly with some police forces—the issue is that the battery life on some of these cameras is not all that it could be, which means that the cameras might not last long enough in all these circumstances. Does he agree that we need better technology for the battery life before we start insisting on these things being used in all circumstances?
It is extremely important that we have adequate and appropriate technology. Of course the battery life of these cameras on the frontline is a key part of that. Police using the system being rolled out in the west midlands, which is partly funded through the Home Office, are confident that they can use the cameras from when they are automatically triggered through to when the footage can be uploaded back at the station. As has already been pointed out, research strongly suggests that the use of force is reduced by about half if body cameras are worn. Attacks on police officers are also reduced. In the west midlands, harm to police officers has been reduced by about three quarters since body cameras started being routinely used, and complaints against police officers have fallen by more than 90% when evidence from a body camera is used.
There has been great progress in the area of mental health, but there is still much more that needs to be done. We need a greater focus on mental wellness, prevention, early intervention and ensuring that primary care is in a position to support and treat our patients at an early stage. There will always be occasions when restraint is appropriate and even a small number of circumstances in which the use of force is necessary. That use of force must be properly regulated, registered, controlled and used as a last resort—when no other adequate course of action is available.
In the first year of general use, there has been a sharp fall in the number of assaults against police officers. There are also fewer complaints against police officers, and the time it takes to handle responses has fallen. It used to take many of hours of investigating and phone calls; now, in some cases, it takes barely minutes of reviewing clear body camera evidence.
The measures in the Bill are necessary and welcome, so I wholeheartedly support it today and look forward to supporting it in its passage through this place.
I join Members across the House in congratulating Mr Reed on bringing the Bill before us today. I thank him for the constructive way in which he has engaged with me and my officials. I look forward to taking this Bill further—hopefully completing its journey—so that we can bring Seni’s law to the statute book.
The death of the hon. Gentleman’s constituent, Seni Lewis, was a tragedy. I know that the hon. Gentleman has been deeply touched by the incident—so touched that he has brought forward this Bill, with an impressive coalition of interests behind it. May I send my very best wishes, through the hon. Gentleman, to Seni’s family? It must be an incredibly difficult time for them and I extend my deepest sympathies to them.
As we have heard, the Bill seeks to reduce the inappropriate use of force or restraint against people with mental ill health, to allow greater scrutiny of the use of force in mental health units, and to ensure that police officers use body-worn video cameras in the course of their duties in relation to people in mental health units. It also seeks to guarantee that the mental health system learns from and applies appropriate lessons in relation to the use of force. For too long, restrictive interventions have been accepted as the norm in health and mental health care settings, and we want to change that culture. That is why the Government support the principles set out in the Bill.
It is important to note that there were 67,864 incidents against NHS staff in 2015, 67% of which took place in a mental health setting. We need to appreciate that there is a need for force, because staff working in these situations sometimes need to be protected.
My hon. Friend makes a valid point but I think that we are all agreed in this House—certainly in this debate—that we need to balance rights and liberties with the need to achieve safety. I can say, quite categorically, that this Bill goes a long way towards achieving that.
The Government support the principles set out in the Bill, but we accept—as I think the hon. Member for Croydon North would—that there is still some work to do on the detail regarding the right mechanisms and processes. We can explore those matters in Committee and we are fully behind the Bill’s Second Reading.
I agree with that point very ably made by my hon. Friend. The Bill brings real accountability and transparency, which will protect everyone in the system.
I welcome the opportunity to debate the Bill, and to highlight some of the progress we have already made on some of the provisions that the Bill seeks to introduce and strengthen. First, we should examine the issue of restrictive restraint. It is not a great picture, to be frank. Information from NHS Digital shows that more than 6,000 people who spent time in hospital in 2013-14 were subject to at least one incident of restraint. Collectively, these people experienced more than 23,000 incidents of restraint, with 960 people having been restrained five or more times in a year. As colleagues across the House have said, that can cause real trauma and should be avoided at all costs. The group who experienced the highest proportion of restraint per 1,000 inpatients was the category labelled “mixed ethnic group”, with 101 incidents of restraint per 1,000 in-patients. We need to get to the bottom of why that is the case. There is a link between the use of restraint and particular points in the patient pathway. For example, in 2015, the survey of restraint commissioned by the Government found that 23.6% of restraint incidents occurred in the first week of admission. We have discussed gender, and I can confirm that 54.7% of people who were restrained were men, compared with 42.5% being women. That clearly does not reflect the gender balance of people in detention.
Members have referred to the fact that on Monday the House welcomed the publication of Dame Elish Angiolini’s independent review of deaths and serious incidents in police custody, and the Government response. The report is thorough and identifies room for improvement at every stage in procedures and processes surrounding deaths in police custody. It makes 110 recommendations on the use of restraint, on training for officers and on making it easier for families facing an inquest into a death in police custody to access legal aid. The hon. Member for Croydon North is concerned about that issue.
The extent to which restraint techniques contribute to a death in custody and whether current training is fit for purpose is a crucial aspect of Dame Elish’s report. Police training and practice emphasise that under certain circumstances any form of restraint can potentially lead to death, so the National Police Chiefs Council and the College of Policing continue to ensure that legal, medical and tactical advice are embedded in the national personal safety manual, especially in relation to the challenges of prone restraint and mental health issues.
Members have expressed views on the use of restraint, particularly prone restraint, with some of them suggesting that that type of restraint should be banned altogether. I was at Broadmoor yesterday, and I was told about a man who had experienced a head injury and needed stitches. Because of the challenges of his behaviour and mental health condition, prone restraint was used. I am not condoning the use of prone restraint in that situation or in any other, but I will say some words of caution. We need to understand restraint and define it clearly before introducing an outright ban. The guidance says that prone restraint should be used only as a last resort, and we must be careful not to put staff at risk by introducing a blanket ban without understanding more about the circumstances in which that type of restraint might be necessary.
In August this year, the CQC published its report, “The state of care in mental health services 2014-2017”, which identified variations in the frequency with which staff used restrictive practices to manage people with challenging behaviour. It is looking at the issue more closely, and it has committed to reviewing how it assesses the use of restrictive interventions, including developing and regularly updating tools for inspection teams to ensure consistency of assessment and reporting. We believe that the variations are as much due to the principles behind the making of reports as differences in behaviour.
As part of its annual report, “Monitoring the Mental Health Act”, the CQC is developing a publication to highlight areas of good practice in reducing the need for restrictive interventions. Colleagues at the CQC have indicated that they support the principles of better reporting, improved training and accountability, and greater transparency under the Bill, and it is vital that we engage with that as we take this forward.
Turning to the measures in the Bill, there is provision for front-line staff to receive training in equality and non-discrimination, as well as awareness of conduct prohibited under the Equality Act 2010; a trauma-informed approach to care; and, critically, techniques to avoid and reduce the use of force. Individual providers are expected to ensure that all their staff are appropriately trained in the use of force, and there are many training programmes available to health service providers The Bill will help us to address the variation across the system in the training received by staff. Healthcare providers are encouraged to focus training on de-escalation and on understanding the causes of challenging behaviour, and to reflect on incidents of restraint to see how they can be reduced or avoided for both the individual concerned and for all service users.
Treating and caring for people in a safe, compassionate environment both for patients and staff is a priority for this Government. We know that restrictive physical interventions are risky for all individuals involved and that they have a negative impact on patients’ dignity and their trust in services. We have made progress since the publication of “Positive and proactive care: reducing the need for restrictive interventions” in April 2014. This guidance focuses on the use of preventive approaches and de-escalation for managing behaviour that services may find challenging. It also recommends that all restrictive interventions should be for the shortest time possible and use the least restrictive means to meet the immediate need. The guidance introduced an expectation that services develop restrictive intervention reduction plans. These plans, along with organisations’ relative use of restraint in comparison with other organisations, form a key focus of the CQC inspections. We expect the CQC to use its regulatory powers to ensure that services minimise the use of force and other restrictive interventions, including face-down restraint.
Our colleagues in the police are training officers on how to respond to calls that relate to those with mental health conditions and people with learning difficulties. The revised national police guidance on authorised professional practice on mental health was published by the College of Policing in October last year. It aims to give officers the knowledge they need to resolve situations and ensure that the public get the most appropriate service. While the police are not, and are not expected to be, mental health professionals, they are often first on the scene at incidents involving those experiencing a mental health crisis. The aim is therefore to ensure that officers can respond appropriately.
On data collection, the Bill seeks to gain more detailed information in relation to incidents of force used in mental health settings. From January 2016, NHS Digital has collected information about the use of face-down restraint as part of the mental health services dataset. There is still a lot of work to be done on the quality of the data, as the hon. Member for Croydon North said, as they do not currently go into the amount of detail that the Bill would require. However, we are confident that we can make changes to improve the transparency of the information that we collect.
claimed to move the closure (
Question put forthwith, That the Question be now put.
Question agreed to.
Question put accordingly, That the Bill be now read a Second time.
Question agreed to.
Bill read a Second time; to stand committed to a Public Bill Committee (