Dangerous forms of restraint are used all too often against children and young people in mental health services
We know from young people that good inpatient care in mental health facilities can save lives, and give them the help they need to start their recovery. Healthcare staff do a challenging job and often need to manage complex situations, sometimes without adequate training.
However, currently, the use and threat of force is being used too often against people in mental health hospitals across the country. Some groups, such as children, young people and women are disproportionately likely to be subject to the use of force in mental health units; while young black males are most at risk of death from inappropriate force, and those on the autism spectrum or with a learning disability are at increased risk of being unnecessarily and frequently restrained.
Young people tell us that being restrained, isolated, or experiencing coercion is frightening, traumatic and humiliating. The use of force in inpatient care often undermines a patient’s recovery, puts them at risk of injury, psychological harm, trauma, and in the most tragic circumstances, death.
Shockingly, young people are actually more likely to be restrained than adults in mental health hospitals. Data from 2016 and 2017 found that young people under the age of 20 were four times more likely to be subject to the use of force in mental health inpatient units than adults. Indeed prone (face-down) restraint – the most dangerous type of restraint – was used more than 2,500 times on young people in 2014 and 2015. This is despite guidance stating that restraint and other forms of force should be avoided wherever possible against children and young people, and that prone restraint should be phased out.
At YoungMinds, we regularly speak to children and young people who have accessed inpatient mental health hospitals, and their families. Young people and their families consistently tell us that they do not know what their rights are regarding the use of force, their right to advocacy or their rights to be involved in decisions about their care and treatment. This isn’t good enough.
Last November, we, alongside the National Autistic Society, submitted a petition to the prime minister, signed by over 10,000, which called for a charter of rights – something that should always be applied to inpatient mental health services for children and young people. One of the principles that young people and their families called for was to always be treated with dignity and respect, which included avoiding the use of restraint (including chemical restraint), isolation and seclusion wherever possible.
It is not news that services across the country are patchy and inconsistent. But this also applies to the variation in transparency and oversight of the use of force across the country, which leads to a postcode lottery in the experience of mental health patients. More than one in six providers of child and adolescent mental health services (CAMHS) did not know how often patients had been restrained in their services in 2016.
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Race and restraint: it’s time we listened to the evidence
A number of international bodies, including the UN Convention on the Rights of the Child, and the Special Rapporteur on Torture, have expressed serious concerns about the use of restraint and seclusion on children and young people in UK hospitals. On top of this, regulators and inspectorates in the UK – including the children’s commissioner and Care Quality Commission – have conveyed similar concerns about the lack of appropriate oversight, transparency and accountability.
This is why Seni’s Law is such a crucial bill. The bill would lead to the systematic recording of any use of force, improved accountability, and training for staff on de-escalation techniques. Crucially, the bill would also ensure that every mental health unit has a policy on the use of force and that this policy is communicated to patients, and where appropriate, their families too.
We welcome the continued cross-party support for the bill, and hope it can be maintained to ensure it is strengthened and improved, when it enters report stage, and has its third reading next week.
There has been a clear consensus across the mental health sector about the positive impact that the bill will have on patients, families and professionals alike. In October, we coordinated a letter demonstrating the support of the sector for the bill, which was signed by the chief executives, presidents or directors of 28 organisations and royal colleges, including INQUEST who have worked closely with Seni’s family.
There is a consensus amongst the charities that the bill still needs to be improved to ensure that there are adequate safeguards and protections for mental health patients from inappropriate uses of force.
So, on Friday 15 June, us at YoungMinds, along with a host of other organisations, will be calling on MPs to vote for Seni’s Law during its third reading, and to make the necessary improvements to the bill at report stage.
In particular, we must establish greater transparency about the use of threats and coercion within mental health units; for patients to be made aware of their existing rights to advocacy and how to access an advocate; and for the bill to achieve its overall aim, by placing a commitment to reducing the overall use of force.
If we get this bill right, it will be a landmark moment in improving the way that we as a society treat children, young people and those going through a mental health crisis in our hospitals. We have a duty to get this right.
Matt Blow is policy manager at YoungMinds. He tweets @MattBlow_
To find out more about the work of YoungMinds, visit www.youngminds.org.uk
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