Progress | Centre-left Labour politics

Restraint and race: it’s time we listened to the evidence

We are suffering from decades-old problems when it comes to the use of excessive restraint in mental health services and police custody

This year marks 20 years since the death of David ‘Rocky’ Bennett, who died following prolonged face down restraint whilst a patient in a mental health unit. His death sparked an independent inquiry, which was hailed by many as the Macpherson report of the mental health services. Concluding in 2004, the inquiry highlighted the institutional racism that had been present in mental health services, both NHS and private, for many years.

It was hoped that the inquiry would mark a turning point for mental health services, and go some way to addressing a pervasive view amongst many health professionals that black men with mental ill health were ‘big, black and dangerous’. However, numerous deaths since Rocky’s have confirmed that there is still a very long way to go.

For almost 40 years, INQUEST has worked alongside bereaved families seeking truth, justice and accountability for relatives who have died in settings including police custody and mental health care. We have long running concerns about the disproportionate use of force against black people, as well as other people from ethnic minorities.

Analysis of INQUEST casework and monitoring shows the proportion of deaths in police custody of people from Black, Asian, and minority ethnicities (BAME) where use of force is a feature is over two times greater than when looking at white deaths in custody. Due to shortcomings in available data, it is not possible to replicate this analysis for deaths within mental health settings. However, there is evidence that BAME people are disproportionately subject to restraint in mental health units.

All too often, bereaved families are told that ‘lessons will be learned’. However, ten years after Rocky’s death, in 2008 Sean Rigg died after being restrained by police officers during a mental health crisis. The inquest found that unsuitable and unnecessary force was used by police, and that the mental health professionals tasked with Sean’s care had failed in multiple areas. The highly critical inquest led to an independent review of initial investigations into Sean’s death. The author of the 2013 review, Dr Silvia Casale, made numerous recommendations on investigating and learning from deaths. They included the importance of considering long term mental health care, and of recognising the significance of contentious factors such as mental health, restraint and race.

More coverage on Seni’s Law:
Support for women in mental health services must be better
Why we need Seni’s Law
How can we rid our mental health services of racism?
Young people should not have to face the fear of excessive restraint

In 2010, Seni Lewis died following prolonged restraint by 11 police officers whilst a voluntary inpatient in a mental health hospital. An inquest found that multiple failures by health staff led to police being called, and that the force used was excessive, unreasonable, unnecessary and disproportionate. Seni’s death was yet another tragic and needless loss of life. Campaigning by INQUEST and bereaved families including Seni and Sean’s led to the first independent review of deaths and serious incidents in police custody, conducted by Dame Elish Angiolini and published in October 2017.

The report recommended tackling discrimination through recognition of the disproportionate number of deaths of BAME people following restraint, and the role of institutional racism both within post-death investigations and police training. It concluded that an unambiguous and high threshold should be set for police involvement in any health care setting, and that section 136 ‘places of safety’ in police custody should be completely phased out. It also recommended that national policing practice and training must reflect the widely evident truth that use of force against those in mental health crisis poses a life-threatening risk.

Another legacy of the deaths of Rocky, Sean, Seni and so many others is the Mental Health Units (Use of Force) bill, known as ‘Seni’s law’, which is currently passing through parliament. The bill is a welcome attempt to bring some of the important changes needed into legislation, not just for those who are disproportionately affected by use of force, but for the many thousands of people who access mental health care, and deserve these protections. If enacted, the bill could mean we have a far better understanding of the extent of the disproportionate use of force against groups including BAME people. It would bring improved regulation and oversight, which could reduce the levels of force used. And we hope it could mean that deaths and serious incidents involving use of force in mental health settings are always subject to an independent investigation, as they would be in police custody.

In the 20 years since Rocky’s death it has become clear that there is no silver bullet for addressing the persistent and life threatening institutional racism in health and custodial institutions. If health services and the police want to change, the blueprint is out there in the many recommendations and reviews which have followed previous deaths. There is hope that this issue will be properly considered in the ongoing review of the Mental Health Act. Seni’s Law, if passed, will be a hugely significant step forward. We cannot wait for more needless and preventable deaths before these important lessons are truly learned.

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Lucy McKay is the policy and communications officer for INQUEST.

Learn more about the work of the charity on www.inquest.org.uk or on twitter @INQUEST_ORG

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Lucy McKay

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