Progress | Centre-left Labour politics

Support for women in mental health services must be better

Why are girls so much more likely to be restrained than boys? The nature of mental health issues and the application of restraint in hospitals shows that we need a gender-specific approach to care, writes Agenda’s Katharine Sacks-Jones

The introduction of Seni’s Law could transform the treatment of patients in mental health settings. Steve Reed’s private members’ bill aims to significantly reduce the use of restraint against patients in mental health units, which remains too widespread.

The changes will make a real difference to women like Pamela, who was physically restrained a number of times, including in the face-down position, when she was receiving treatment in a mental health hospital:

‘You are lying down, face on the floor, you can’t hear, you can’t see and it is really, really scary. If you resist, sometimes they put pressure on specific joints on your body which is just horrific,’ she says.

Physical restraint like this continues to be used routinely against women and girls in mental health facilities, according to research carried out by Agenda.

We found that one in five women and girls have been physically restrained in mental health settings and that the use of face-down restraint continues to be widespread, with women and girls subject to this on thousands of occasions.

Girls in particular were more likely to be restrained than boys – with nearly 2,300 incidents of face-down restraint against girls, compared with fewer than 300 against boys.

Being physically held down and having your clothes pulled out of place, often in front of others, can be an extremely humiliating, frightening and potentially dangerous experience. It is unlikely to improve mental well-being in the short or long-term – and in fact can often do the opposite.

The widespread use of restraint is particularly concerning because of the potential it has to bring back memories of abuse and re-traumatise those who have experienced abuse.

More than half of women with a mental health problem have experienced some form of abuse. This needs to be understood and responded to by mental health services as it is vital to helping women get better.

More coverage on Seni’s Law:
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
Race and restraint: it’s time we listened to the evidence

That is why Agenda’s Women in Mind campaign is calling for women and girls’ experiences, especially their histories of violence and abuse, to be taken into account and support given to tackle the underlying issues they face. This means gender-specific and trauma-informed care.

By helping reduce restraint, the Mental Health Units (Use of Force) bill – Seni’s Law – is a vital first step towards this.

As well as measures improving transparency and accountability in mental health practice, it includes introducing training for mental health practitioners in the impact of trauma on a person’s mental health.

Practitioners would also be trained in de-escalation techniques to that they have tools to manage a situation without having to resort to restraint.

Mental health units are meant to be caring places for women and girls feeling at their most vulnerable, not places where physical force is routine. We hope that following the introduction of this bill, restraint will only ever be used as a last resort.

But there are also other upcoming opportunities to ensure that trauma-informed and women-specific support is integrated into all aspects of mental health care.

The Mental Health Act review this year offers a vital chance to ensure women and girls are not re-traumatised during the process of detention; and the Women’s Mental Health Taskforce, which I co-chair with health minister Jackie Doyle-Price, will report in the summer, and hopes to introduce important steps for improving women’s mental wellbeing. And we have already seen some progress for women – NHS England recently announced that survivors of sexual assault would receive counselling for life as part of their sexual assault strategy.

We hope this bill will change the experiences of thousands of traumatised women and girls using inpatient mental health services – but we need a much greater change of emphasis in mental health care more broadly if we are to see mental health facilities being the compassionate, therapeutic environments they should be.


Katharine Sacks-Jones is director of Agenda and co-chair of the Women’s Mental Health Taskforce. She tweets @KatharineSJ

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Katharine Sacks-Jones

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