Training in appropriate use of force

Mental Health Units (Use of Force) Bill – in a Public Bill Committee am 9:45 am ar 28 Mawrth 2018.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society) 9:45, 28 Mawrth 2018

I beg to move amendment 86, in clause 5, page 3, line 33, leave out subsection (1) and insert—

‘(1) The responsible person for each mental health unit must provide training for staff that relates to the use of force by staff who work in that unit.

(1A) The training provided under subsection (1) must include training on the following topics—

(a) how to involve patients in the planning, development and delivery of care and treatment in the mental health unit,

(b) showing respect for patients’ past and present wishes and feelings,

(c) showing respect for diversity generally,

(d) avoiding unlawful discrimination, harassment and victimisation,

(e) the use of techniques for avoiding or reducing the use of force,

(f) the risks associated with the use of force,

(g) the impact of trauma (whether historic or otherwise) on a patient’s mental and physical health,

(h) the impact of any use of force on a patient’s mental and physical health,

(i) the impact of any use of force on a patient’s development,

(j) how to ensure the safety of patients and the public, and

(k) the principal legal or ethical issues associated with the use of force.’.

This amendment replaces Clause 5(1) with a revised duty on the responsible person to ensure that training is provided for staff that covers a wide range of topics relating to the use of force in mental health units.

Photo of Karen Buck Karen Buck Llafur, Westminster North

With this it will be convenient to discuss amendment 87, in clause 5, page 3, line 39, leave out subsection (2) and insert—

‘(2) Subject to subsection (2A), training must be provided—

(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or

(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.

(2A) Subsection (2) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—

(a) was given sufficiently recently, and

(b) meets the standards of the training provided under this section.

(2B) Refresher training must be provided at regular intervals whilst a person is a member of staff.

(2C) In subsection (2B) “refresher training” means training that updates or supplements the training provided under subsection (1).’.

The amendment sets out when training under Clause 5 should be given to staff. A definition of “staff” is given in NC7.

Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society)

These amendments are to the clause relating to improving training for staff working in mental health units before they are able to use force of any description against patients. It is clearly better for patient safety that any staff administering force should be properly trained, but it is worth noting that it is also important for staff safety that they are properly trained before they engage in administering force to patients.

Photo of Helen Hayes Helen Hayes Llafur, Dulwich and West Norwood

I commend my hon. Friend for introducing the Bill. On the need for training, I want to flag my experience of young patients with autism being held in secure psychiatric units. In my experience, there is a lack of expertise and training across the board for staff treating young people with autism, so they fail to understand that much challenging behaviour arises from the intense levels of anxiety experienced by young people with autism. In such circumstances, the use of force further compounds that anxiety, and indeed traumatises those young people. I ask the Minister whether, when laying down guidance to accompany the Bill, specific regard will be given to the lack of training and understanding of autism within our mental health services?

Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society)

I am grateful to my hon. Friend for making that important point and I look forward to hearing the Minister’s comment. That point has been made to me by many service users and advocacy groups, including Rethink Mental Illness, YoungMinds and others.

Many of the approaches outlined in the Bill ought to be applied more widely for people who experience mental ill health in many other circumstances. I hope that the Government’s ongoing review into mental health will do that. I hope that some of the principles in the Bill will take us forward and allow that review, when it reports back, to make a bigger impact than it perhaps might have made otherwise.

Moving back to the principles of training in general, the Bill includes provisions on training to recognise the Equality Act 2010 and de-escalation techniques that reduce the need for force to be used in any circumstances. The amendment will also strengthen the requirement for trauma-informed care. It is important to include in the Bill that staff are trained in the impact of further traumatising patients, whose mental ill health may have already been exacerbated by forms of trauma.

I am informed by Agenda that more than 50% of female patients in mental health units have experienced physical or sexual abuse by men, which in most cases contributes significantly to their mental ill health. After those experiences, being forcibly restrained—generally by groups of men—can further traumatise those women and make their mental health conditions even worse, so it is very important that staff are fully aware and trained in the risks of re-traumatising patients who have already been traumatised.

It is also important that training takes full account of the risks of unlawful discrimination regarding race. Dame Elish Angiolini’s report last year into deaths and serious incidents in police custody found that:

“The stereotyping of young Black men as ‘dangerous, violent and volatile’ is a longstanding trope that is ingrained in the minds of many in our society.”

We only have to look at pictures of the faces of people who have died in state custody, including in mental health custody, to see how severe the risk of unconscious bias in the system is. A much higher proportion of those faces will be of young black men than the proportion present in the population as a whole. In order to ensure that staff will not be acting out of prejudice against people who enter a publicly funded health service for treatment on equal terms with everyone else, it is important that staff are trained to be fully aware of the risks of unconscious bias and racism in that service.

Putting anti-discrimination training into legislation is a move towards ending such unlawful discrimination, as is the overall aim of the Bill, and towards exposing the use of force to much closer scrutiny by standardising data recording across the whole country, so that it is possible to compare performance in mental health units on the same basis in different parts of the country. That is not currently possible, and it is a loophole that was pointed to by Dame Elish Angiolini in her report. I am pleased that the Bill will close the loophole.

Crucially, staff must also be trained in the use of techniques to avoid or reduce the use of force—essentially de-escalation. That makes the situation safer for everyone involved. It is critical that anything that might trigger behaviours in a patient that could lead to their being restrained should be avoided, if at all possible, so that the use of force can be minimised.

Amendment 86 sets out a revised duty on the responsible person to ensure that training is provided for staff in mental health units. Amendment 87 sets out when training should be provided to staff. It should be provided as soon as the provision comes into force, and there should be refresher training at regular intervals. That will build the institutional knowledge needed to ensure that force will only ever be used as a genuine last resort.

Photo of Luciana Berger Luciana Berger Labour/Co-operative, Liverpool, Wavertree

My hon. Friend, and many other Members, will probably have seen the “Dispatches” programme last month, in which a temporary member of staff went to work in a privately owned but NHS-funded mental health unit. That undercover report revealed scenes that were difficult to watch. Part of the challenge was that the individual was not given any appropriate training when she was asked to care for some very unwell people in secure parts of the accommodation. I want to reinforce what my hon. Friend has been saying: the issue is critical for existing and new staff, and often there are too many temporary staff working in such units.

Photo of Steve Reed Steve Reed Shadow Minister (Digital, Culture, Media and Sport) (Civil Society)

My hon. Friend makes an important point, clearly and eloquently. There are no circumstances in which an untrained member of staff, whether full-time or not, should be able to use force—effectively violence—on a patient. If they have not been properly trained, that should be an absolute no.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

The clause relates to ensuring that all members of staff are appropriately trained on when it is appropriate to use force. It is worth emphasising that it will make any institution or organisation safer for patients, but also for staff. It is important to prioritise and enhance training in de-escalation techniques. That will make for a safer environment for everyone, with less harm to patients, and will probably help to some extent with their continuing care and recovery. I totally endorse the clause, and the amendments, which will make it more effective. Clearly these measures are important for a Government whose approach to leadership in health involves prioritising patient safety.

We see the provisions as an opportunity to build on the positive and proactive care guidance. The amended clause will now go much further to address the points made by the hon. Members for Croydon North and for Liverpool, Wavertree. Only people working in a professional capacity would be able to use force on patients; any volunteers would not be able to do so. In that sense, it is a much stronger measure, because we are giving a clear view that the use of force is not something that volunteers should be involved in.

I recognise the points that were made earlier about the role of temporary staff; we should perhaps reflect on what happens in some organisations that rely heavily on temporary staff, and perhaps build that into the guidance on this clause. I am glad to see that the broader definition of staff includes senior staff as well as those on the frontline. It is important that, in building that culture of accountability for the use of force, we ensure that the senior leadership of organisations recognise that they are responsible for that. The Government are content to support these amendments.

The hon. Member for Dulwich and West Norwood raised an important point about young people with autism and appropriate care in a given context. Clearly, people with autism will react differently from people with other behavioural issues, and that would have to be taken on board in training. The same goes for women. The reality is that in any confrontational situation there is always the opportunity for discrimination where people have a weakness or are less empowered to look out for their own interests. We need to ensure that any guidance and training deals with that.

The issue of people with autism is close to my heart and something that I will reflect on. With regard to women, I can advise the hon. Member for Croydon North that I am working closely with Agenda, and through the women’s mental health taskforce, to address exactly the points he makes about trauma-informed care.

Amendment 86 agreed to.

Amendment made: 87, in clause 5, page 3, line 39, leave out subsection (2) and insert—

‘(2) Subject to subsection (2A), training must be provided—

(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or

(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.

(2A) Subsection (2) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—

(a) was given sufficiently recently, and

(b) meets the standards of the training provided under this section.

(2B) Refresher training must be provided at regular intervals whilst a person is a member of staff.

(2C) In subsection (2B) “refresher training” means training that updates or supplements the training provided under subsection (1).’ —

The amendment sets out when training under Clause 5 should be given to staff. A definition of “staff” is given in NC7.

Clause 5, as amended, ordered to stand part of the Bill.

Clause 6