New legislation brought in by the Department of Health and Social Care (DHSC), will as of today give greater protection to patients in mental health settings, to prevent them from inappropriate use of force.
The Act, also known as Seni’s Law, is named after Olaseni Lewis who died after being forcibly restrained in 2010
The legislation will ensure all NHS trusts are clear on when it is absolutely necessary to use force/restraint, as well as bringing in greater accountability and transparency for when it is used. This will be upheld by improved record keeping and reporting on instances of use of force, as well as ‘quality staff training’ and improving ‘the way in which investigations are carried out.’
“This is my son’s legacy, and I hope it will mean what happened to Seni will not happen to anyone else.” Said Aji Lewis, Seni’s mother.
The Act clearly states the measures needed to prevent inappropriate use of force and to increase accountability and transparency in mental health units, ‘ensuring patients are treated with dignity and respect at all times.’
Minister for Mental Health, Gillian Keegan has spoken on the act saying: “It is vital anyone receiving care in a mental health setting - a time which can be incredibly distressing - is treated with dignity and respect. Today’s legislation and guidance is an important step forward to ending the disproportionate and inappropriate use of force - protecting both patients and our fantastic workforce - within our mental health services. We must ensure what happened to Seni does not happen to anyone else. I want to thank Seni’s family, particularly his mother Aji, and Steve Reed MP for driving this work forward.”
Olaseni Lewis was killed as a result of the disproportionate restraint received while they had voluntarily admitted themselves into a mental health unit in South London. As such, the guidance being passed on to NHS trusts has been developed with mental health professionals, as well as people with lived experience, the NHS and most importantly, Aji Lewis (Seni’s mother) and Seni’s family.
Speaking on this Act, and the sad legacy of her son’s death, Aji Lewis said:
“It’s so good to see the guidance published today and the Act being commenced…I look forward to continuing to work with the government and mental health providers to make sure the act is properly implemented, and real change is achieved.”
The law, which received Royal Assent on the 1st of November 2018 will now hopefully protect some of the most vulnerable in mental health services from further trauma or even death
This progress in transforming the Mental Health Act (MHA), so that it protects those who may already be vulnerable to discriminatory actions or behaviour within mental health services, is both welcome and necessary.
Earlier this year the Sewell Race Report acknowledged that racialised peoples, especially young Black, Afro-Caribbean men are being restrained disproportionately by mental health services, especially when they come into contact with them as a result of being sectioned under the MHA, but did not do enough in it’s conclusions to address this issue.
Speaking on the Act, which was originally a Private Members’ Bill by Croydon North Labour MP Steve Reed, (the constituency that Seni lived in at the time of his death), Mr Reed said: “I’m delighted the guidance for Seni’s Law has now been published and a date is in sight for the Act to come into force."
"Seni Lewis died in tragic and avoidable circumstances. His legacy is this Act and the changes it makes to ensure people with mental ill health are treated with care, compassion and respect."
- See also: 'The Sewell Race Report fails the lived experiences of mental health service users'
- See also: 'The criminal justice system is failing people with mental health issues, says inspectorates'
- See also: 'Racial inequalities will remain in mental health systems without investments, says RCPsych'
The issue at the heart of the original bill and now this Act, is that of the structural racism present in mental health services. In a statement on the Use of Force Law, mental health charity, Mind make pains to acknowledge this fact, which is somewhat missing from the DHSC’s own statement:
‘Practises 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.’
Other aspects of the legislation that Mind emphasises is the requirement that at the end of every year, the Secretary of State must analyse and publish all data and records relating to use of force. Even more importantly, the Act requires that any police officer entering a mental health unit to aid staff in retraining a patient, must wear a body camera.
Paul Farmer, Chief Executive of Mind reflected on the necessity of this Act, and those it needs to protect:
“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, a young man from London, now 24, was diagnosed with bipolar disorder at the age of 15, and who also has a learning disability called XYY syndrome. Having last experienced use of force through restraint in 2015, he spoke to Mind on his experience: “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.”
This law inevitably also sits on the intersection of those with mental health disorders and those with learning disabilities as well as neurodivergence’s, meaning it is all the more essential to understand people’s behaviour within their own unique context, to see them as individuals and not attempt to apply an ‘impersonal’ approach when someone is in crisis.
Hannah, 22, who once worked as a forensic recovery support worker in the community has been diagnosed with borderline personality disorder (BPD), and recently experienced restraint in April of this year. She also spoke to Mind about her perspective, from both the service user point of view and as someone who received the training as it was before this Act came into law.
“Rather than focussing 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…Sometimes there are six people who pin you to the floor…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…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.”
We join Mind in feeling a reserved kind of hope for this new legislation, hoping that the work necessary to bring it into practical action will be swift and immediate. However, as Mr Farmer of Mind said, this issue is part of a larger, systemic problem and to sustain this new legislation we must also look at the systemic racism and attitudes that upheld the response like that shown in the case of Seni’s death.