Mind welcomes 2018 Mental Health Units (Use of Force) guidance to curb restraint on people with mental health problems
Mind responds to and welcomes guidance to stop use of restraint on people with mental health problems in hospital.
The Mental Health Units (Use of Force) Act became enshrined in law after receiving Royal Assent on 01 November 2018. More than three years later, the UK Government has published statutory guidance and regulations outlining how and when the law will be enforced, bringing the 2018 Mental Health Units (Use of Force) Act into operation.
This means every mental health unit will have to publish a policy setting out what steps will be taken to reduce the use of force by staff working in that unit.
The 2018 Mental Health Units (Use of Force) Act was originally a Private Members’ Bill by Steve Reed, Labour MP for Croydon North, following the horrendous death of one of his constituents. Olaseni (‘Seni’) Lewis was a 23-year-old Black man who died at a mental health facility after being restrained by 11 police officers. An inquest found that this restraint was excessive, unreasonable, and disproportionate. Seni’s family, friends, MP, and others in the mental health community have been campaigning to push this Bill through Parliament and into force ever since.
For several years, Mind has been campaigning against the use of force and physical restraint, as well as structural racism within mental health services. Practices like face-down and chemical restraint can be humiliating and life-threatening and disproportionately affect Black men like Seni. As a result of systemic racism within the Mental Health Act, healthcare professions are more than four times more likely to section Black people than white people and are over four times more likely to restrain or hold Black people in isolation while in hospital.
This enforcement is urgently needed, and it is important to get it right so that implementation of the 2018 Mental Health Units (Use of Force) Act is as effective as possible. As a result of this Act, each mental health unit must publish information about patients' rights in relation to the use of force. All mental health trusts must foster safe, therapeutic, inpatient care, which is respectful of people and their rights, and not reliant on force. Mental health units must provide training for staff and each mental health unit must keep a record of any use of force by staff who work in that unit where the use of force is not "negligible". At the end of each year the Secretary of State must make sure statistics relating to the records collected are analysed and published. Importantly, if a police officer is going to a mental health unit to help staff, the officer must wear a body camera.
Paul Farmer, Chief Executive of Mind, said:
“What happened to Olaseni (‘Seni’) Lewis was found to be excessive, unreasonable and disproportionate by an inquest– not to mention horrifying and inhumane. Being restrained by 11 police officers led directly to the awful death of this young man who needed and deserved compassionate treatment for his mental health. A mental health ward should be a therapeutic environment where people receive care and support to help them get better. We are pleased to see the Mental Health Units (Use of Force) Act (also known as Seni’s Law) finally come into force, but it can’t bring Seni back. It’s important this law reduces the use of force on mental health units, so nobody has to experience what Seni’s loved ones have been through.
“The pervasive use of force in mental health units underlines just how important full implementation of this law is. In 2020-21, 3,436 people were subject to face-down or ‘prone’ restraint- the most dangerous and life threatening. Black people – particularly men – are still far more likely to be detained under the Mental Health Act and restrained against their will. As well as implementing Seni’s Law, we need to see fully funded reform of the Mental Health Act that acknowledges and tackles structural and institutional racism.”
Chris is 24 and from London. Chris was diagnosed with bipolar disorder aged 15. Chris was last restrained in 2015.
“I was born with XYY syndrome which makes it hard to learn, and I was bullied at college, which had a negative impact on my mental health. I’m black and 6ft 3, and I’ve been stopped by the police six or seven times in the community – it’s unfair this is more likely to happen because you are black and tall – racial trauma has a huge impact on mental health.
“In 2015, I had a breakdown while walking along the street. The police tried to taser me, restrained me, and took me to a teenage secure unit where I was sectioned under the Mental Health Act. Once I was in hospital, I was restrained again by hospital staff – being restrained feels like a way of controlling you through force - you already feel scared and confused because you don’t understand what is going on - especially when you have mental health problems and a learning disability. After being restrained, I’d have nightmares which were scary, it’s like living it repeatedly.
“I wasn’t offered a choice about my treatment, I was just sectioned and taken to hospital. It makes you feel like you’re not a person. Hospital staff don’t tend to understand learning disabilities and they can treat you badly. Someone said, ‘you don’t look like you have a learning disability’. Once I left hospital, nobody followed up with me. I think there needs to be more support in the community to make sure you’re doing ok and getting the mental health support you need so you don’t go back to hospital.
“During lockdown I started new hobbies such as street dance and phone photography – I especially enjoy taking photos of wildlife. Since restrictions have lifted, I have been able to go back to church, which has been great, it helps me socialise and connect with people. I love running and recently I started attending an athletics group in East London, which I love. I’ve got some athletics events coming up, which I’m really looking forward too.”
22-year-old Hannah lives in London. Hannah has been diagnosed with borderline personality disorder (BPD).
“I was last restrained in April 2021. Using restraint and restraint techniques are dehumanising, especially given that you’re meant to be in a place of safety, and it feels like you’re being physically punished for being unwell, with no control over your care. Rather than focusing on verbal de-escalation and sitting down with you, getting on your level, and asking how you can help, staff rely on calling the restraint team in and once that happens there isn’t much you can do or say to stop it happening. Sometimes there are six people who pin you to the floor. This doesn’t help you when you’re unwell, it makes things worse. When I’ve been in hospital, I have spent time on mixed sex wards, and I notice the over-representation of black men and women in hospital. Black men are most likely to be restrained from my experience. I’m Black and white British and I have noticed that people from non-minority backgrounds don’t seem to be restrained as much, staff would spend longer verbally deescalating with them.
“I have seen it from both sides as I used to work as a forensic recovery support worker, based in the community. I’ve received training on restraint and medication. The training isn’t person centred the people carrying out the restraint training try to make it as impersonal as possible, but I think this is unsafe. Hospitals are not getting safer – you can still be injured in hospital – you can still die in hospital.
“This law should have been brought in much earlier, I do hope it helps end restraint and deters people from using force, instead focusing on patient safety and making sure someone gets the care they need. There needs to be more funding for mental health services to make sure hospitals are actually safe.”
For more information about what this law means for mental health units, please visit Mind’s website.