Like other hon. Members, I wish to start by congratulating the hon. Member for Croydon North (Mr Reed) on introducing such an important Bill. I know from my own experience two years ago of being drawn high up in the private Members’ Bill ballot that it can feel a bit of a mixed blessing. There are a few days in the lead-up to publishing the Bill when they are probably among the most popular Members of Parliament; telephone lines and email inboxes are rarely idle. Of course once the simple step of presenting the Bill is done, the really hard work begins, not only in producing the Bill and the explanatory notes, but in starting to build the consensus that allows the Bill to have a reasonable chance of progressing into legislation. The hon. Gentleman has done that exceptionally well to this point, and I know he will be proceeding as he has begun.
I also wish to thank my constituents who have contacted me, some with their own experiences and others with their own views of the current use of force in mental health units. I also thank West Midlands police and the range of organisations with an interest in mental health policy which have briefed us all, shedding new light on both the scale and nature of the problems in the system.
In recent years, mental health has come to the fore in public policy, and much of that is due to the outstanding work done by a number of right hon. and hon. Members
who have a real passion for improving the way mental health is treated and ensuring that parity of esteem is not just a catchphrase but rather that it reflects the way mental health is treated, not only in the NHS, but across public policy and society more widely. In particular, I am thinking of the excellent work done by my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), when he chaired the all-party group on mental health; by the Secretary of State for Health; and by my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and, of course, the right hon. Member for North Norfolk (Norman Lamb), when they were Ministers responsible for mental health.
We have seen the changes in the guidelines and the way sections 135 and 136 of the Mental Health Act 1983 are handled, and the new provisions that will be brought in through the Policing and Crime Act 2017, which gained Royal Assent earlier this year. The political consensus that there is a need to do more is being matched with real progress in both policy and legislation. All of us have welcomed the prominent place mental health reform has had, not just in the Conservative manifesto ahead of the general election, but in its being reflected in the Queen’s Speech and in the Prime Minister’s announcement that the Government would begin a comprehensive review of the Mental Health Act. Public servants who work in the police, the NHS and the justice system are often on the frontline of dealing with people with mental ill health, particularly those affected by acute episodes of mental ill health. My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) was, though, right to question why we always talk about mental health in terms of mental illness, because it is also important to talk about mental wellness and consider how we support, develop and improve people’s positive mental health.
A lot of the changes in the public policy framework in recent years have been driven by innovation in public services. I think in particular of the excellent work done by Inspector Michael Brown, who blogs as Mental Health Cop. He previously worked for West Midlands police, and I think he now works for the chief constable of Dyfed-Powys police. It is largely because of his work that the need to address sections 135 and 136 came to the fore of the public policy agenda. In recent decades, section 136 has set the framework within which people suffering from mental ill are treated in the police and criminal justice system. Although it is part of legislation that is nearly 35 years old, it is barely different from equivalent measures in the Mental Health Act 1959. That was 60 years ago, when there were still asylums in Britain and the whole approach to mental health was completely different. Thankfully, we no longer have asylums and we make huge efforts to treat people in the appropriate settings and in the community. We need to ensure that we adapt not only public policy but a legislative framework that was designed for a completely different society with a completely different outlook on and approach to mental healthcare. The Bill has an important part to play in changing the legislative framework.
In my area, West Midlands police have made substantial progress in how they deal with people suffering from mental illness. In July, the office of the West Midlands police and crime commissioner and the West Midlands combined authority provided an update on and summary of some of their innovations, particularly the model of
mental health triage that has been operating for the past few years. A successful model for mental health triage is being rolled out across the force, throughout the Black country, Birmingham and Solihull. The model relies on an ambulance vehicle, a mental health nurse and a paramedic being available between 10 o’clock in the morning and 2 o’clock the following morning, so that when there is a call-out and it is thought there might be mental health issues to consider, there can be an appropriate health response and health assessment, alongside and as part of the police response. Shortly before I was elected to Parliament, I had the privilege of joining a triage team on a call-out in Birmingham. I saw how it worked and the difference it made compared with the old model of police officers being deployed and, more often than not, somebody suffering from a serious episode of mental ill health ending up in a police cell or another custodial setting.
Let me give an example of how the system has worked. When the police and ambulance services received a report of a 19-year-old female self-harming in the street and threatening to kill herself, a check on the mental health systems was able to establish quickly that she had an extensive history with mental health services. The paramedic had wanted to take the female to an acute hospital immediately, but the deployment of the street triage team meant not only that her wounds could be dressed by the paramedic in the car at the scene, but that the mental health nurse could carry out a face-to-face assessment and make an urgent referral to the home treatment team. As a result, she got crisis access to services overnight and then home treatment the next day, which was a much more appropriate response for somebody going through a crisis. Ultimately, she was safeguarded with a friend for the evening, who took her home and stayed with her through the night, and the whole incident lasted 45 minutes, compared with the many hours it would have taken had she gone to A&E and then other more conventional settings.
The triage teams in the west midlands have treated about 9,000 people in the last year, and as a result—despite the worrying figures we have heard from around the country—the use of section 136 powers in the west midlands has been reduced by about a third over the last five years, from typically 1,200 to 1,300 a year to 852 last year. Remarkably, in the first half of the year, nobody at all in the west midlands was detained in police custody under section 136 of the Mental Health Act—the first time this has ever happened in the west midlands. Instead, more than 8,000 people have received alternative outcomes, including referrals to a GP or other partners, to ensure they get mental health care rather than have their case treated as a purely criminal justice matter.
Although significant progress has been made, and continues to be made, the Bill will help to make further progress, especially through the way it addresses the use of force and restraint against people suffering from mental ill health. Currently, the code of practice clearly states that restrictive practices should only be used where there is a real possibility of harm, either to the patient or to someone else, and should not be used either to punish or inflict pain or suffering, and should be used with minimum interference to autonomy, privacy and dignity. In the case of children and young people, it should not be used at all. Staff should always ensure
that restraint is used only after taking into account an individual’s age, size, physical vulnerability and emotional and psychological maturity.
Although the guidelines exist, further openness around the use of force and restraint is not only welcome and progressive but absolutely necessary for the individuals involved and if our public service workers are to have confidence that their actions are reasonable and defensible. That is why clause 5, which requires that registered managers have a training programme for frontline staff, is particularly important. “Frontline staff” would include all registered managers who might reasonably expect to use force or authorise its use on patients. The proposal to guarantee that staff use the latest and safest procedures should be an opportunity to build on previous learning, not only on mental health care and proportionate use, but on wider issues of equality and necessity.
Clause 6 deals with the requirement on all mental health providers systematically to record information on their use of force. As has been said, if we can measure it, we can track progress and drive changes in behaviour. Including records on the gender, age and ethnicity of patients will help to improve our understanding and, more importantly, the understanding of public services about the use of restraint, particularly on the basis of gender and race.
Let me turn now to body-worn video. Clause 13 provides that on-duty police officers who are called to a mental health unit for any reason must wear body cameras that start recording from as soon as is reasonably practicable. The west midlands, which is within my own force area, is now rolling out body cameras to all its response officers. The kind of body cameras it is using can be automatically triggered by a siren or a blue light, or if airbags are deployed and firearms are drawn. We should consider how these body cameras can be automatically deployed and, without having to think about human error, can automatically stay on until they are manually turned off.