Review of Mental Health Act – new protections proposed for children

The final report of the Independent Review of the Mental Health Act 1983, published today (6 December), makes several very welcome proposals for strengthening the care and protection of children, including:

  • That children’s capacity to consent to admission to a mental health unit, and to treatment for a mental disorder, be based on their understanding and communication, rather than strictly tied to age. The review recommends the Government undertake a consultation on whether parents should continue to be allowed to have children (aged under 16) admitted to mental health units against the child’s wishes. Currently domestic law gives children aged 16 and 17 the right to consent to medical treatment; below this age, consent is dependent upon the child’s understanding. (See a summary of the legal position on our rights4children website).
  • That every child receiving in-patient care should have a care and treatment plan which clearly sets out their views and wishes.
  • That the Government should consider introducing a duty on health providers to support families to stay in touch when a child is placed out of their home area; this could include financial support.
  • That children’s right to independent mental health advocacy be extended to include care planning and making advance choices about care (this would include use of restraint). Very positively, the review recommends that advocacy be opt-out (taking the onus away from patients to seek support) and that children (and adults) in prison awaiting transfer to a mental health unit should have the right to an independent mental health advocate. Independent mental health advocates working with children and young people must be trained for this and providers should be required to produce quarterly reports, incorporating the views of those who have used their services, the review says.
  • Greater attention should be given to meeting the health needs of African and Caribbean children at a much earlier stage, particularly those at risk of school exclusion.
  • That children admitted to a mental health unit be legally defined as a child in need, thus entitling their parents to support from councils under Section 17 of the Children Act 1989.
  • That the Care Quality Commission makes special efforts to obtain the views of children and young people when it inspects and reviews mental health services. It should be notified within 24 hours of every child placed out of their home area.

Read the full report here. Recommendations relating to children and young people, and parents, appear throughout the report and in a dedicated section on pages 167-177.

Government document tells councils they can bypass legal obligations

A document recently published by the Department for Education tells councils what they are allowed to do in respect of the care and protection of children and young people. It is published on the Children’s Social Care Innovation site.

As we wait for responses to our freedom of information (FOI) requests – see below – we have produced a table showing what’s wrong with the document:

What’s wrong with the ‘myth busting’ document Nov 2018

As can be seen, the ‘myth busting’ document claims to be focused on statutory guidance, though it also concerns primary and secondary legislation.

Acts of Parliament are primary legislation. Secondary legislation is also approved by Parliament though with much less scrutiny and debate. Other terms for secondary legislation are regulations and statutory instruments.

Both primary and secondary legislation must be followed.

In addition to complying with the law, local authorities must follow statutory guidance (issued by government departments) unless there is very good reason not to.

Through a series of so-called ‘myth busting’ questions, the Department for Education document claims to summarise the obligations in statutory guidance and then proceeds to set out what the guidance allows. The document states “all of the responses [that is, the ‘what does the guidance allow’ content] have been agreed by the Department for Education and their lawyers in consultation with Ofsted”.

Action to date
Article 39 co-ordinated a letter (with 50 signatories) to the Children’s Minister setting out the legal inaccuracies in the ‘myth busting’ document. We asked him to withdraw the parts of the document which are inaccurate. Six days later we received a response from the Minister. Very regrettably, the Minister did not agree to withdraw the inaccurate content.

Minister's response to joint letter of concern 10 September 2018

After seeking further legal advice, and convening a meeting of concerned organisations, Article 39 submitted the following FOI questions to the Department for Education and Ofsted. Answers to these FOI questions are due tomorrow (16 November).

Our questions to the Department for Education
1) Please provide a copy of the equality impact assessment completed in respect of the Children’s Social Care statutory guidance myth busting document published by the Department for Education (attached with this request).
2) Please provide copies of correspondence between local authorities and the Chief Social Worker for Children and Families, and any other officials within the Department for Education, in connection with the Children’s Social Care statutory guidance myth busting document published by the Department for Education.
3) Please state the date of publication of the Children’s Social Care statutory guidance myth busting document.
4) Please state the date or dates agreement from Department for Education lawyers was sought on the content of the Children’s Social Care statutory guidance myth busting document, and by whom.
5) Please state the date or dates agreement was provided by Department for Education lawyers on the content of the Children’s Social Care statutory guidance myth busting document.

Our questions to Ofsted
1) Please provide copies of correspondence between Ofsted and the Chief Social Worker for Children and Families, and any other officials within the Department for Education, in connection with the Children’s Social Care statutory guidance myth busting document (attached with this request).
2) Please state the date or dates Ofsted was asked to agree the responses to the ‘myth buster’ questions contained within the Children’s Social Care statutory guidance myth busting document.
3) Please state the date or dates Ofsted gave its agreement to the responses to the ‘myth buster’ questions contained within the Children’s Social Care statutory guidance myth busting document.

Royal Assent given to first restraint Act of Parliament

Article 39 is delighted that Royal Assent has been given to the UK’s first Act of Parliament dedicated to protecting children and adults from abusive restraint.

The Mental Health Units (Use of Force) Act 2018 is known as Seni’s Law, after 23 year-old Seni Lewis who died after being restrained by 11 police officers called to the Bethlem Royal hospital in London on 31 October 2010. Seni, an IT graduate, had been admitted to the hospital as a voluntary patient.

  • Last year, 9,296 people were subject to physical restraint in a mental health, learning disabilities or autism service in England; the total number of physical restraints was 53,188 – giving an average of 6 restraints per person.
  • There were 19,078 incidents of physical restraint among 1,198 children and young people (under the age of 20 years) – giving an average of 16 restraints per child and young person. This is nearly three times the overall average.
  • Prone restraint is when a person is held face down onto a surface. There were 3,405 incidents of prone restraint on children and young people (under 20 years old) in England in 2016/17. For all ages, the figure was 10,071, meaning that 34% of face-down restraint were used on children and young people.

With YoungMinds, INQUEST and others, we have been working on the legislation as it made its journey through Parliament.

Carolyne Willow, Article 39’s Director, states:

“This Act of Parliament will massively strengthen child protection within mental health units. Children in these settings are, by definition, extremely poorly and vulnerable, and restraint continues to be used much too frequently and not as a last resort. We offer our utmost respect to the family of Seni Lewis whose courageous fight for justice has ensured child and adult patients have legal rights to dignified, respectful and safe care.” 

Three provisions in the legislation which Article 39 specifically pushed for:

  • Section 5(2)(i) requires that staff training relating to the use of force includes the impact of restraint on a patient’s development. We would have preferred the wording ‘child’s development’ but the meaning is the same – training must specifically include the effects of use of force on children’s development.
  • Section 6(5)(m) requires a description of the outcome of the use of force to be recorded – this means that any injuries and/or psychological harm suffered by children (and adults) will be noted.
  • Section 6(5)(p) requires that records about the use of force indicate whether parents (or others in a patient’s care plan) were notified after each use of force. This is a vital safeguard for vulnerable children who may not tell their parents (or the local authority if they are in care) if they have been restrained. This duty will also benefit adult patients.

Article 39 wanted more protections to be included in the primary legislation but we are very reassured that the Department of Health has agreed that the statutory guidance will specifically – and separately – address the rights and needs of children in mental health units.

We look forward to working on the guidance over the next 12 months, and hope the Government will commence the legislation at the earliest opportunity. (Once an Act of Parliament gains Royal Assent, unless it states otherwise, it is up to Ministers to decide when it will come into force).

 

CHAIR OF YOUTH JUSTICE BOARD TO LEAD REVIEW OF PAIN-INDUCING RESTRAINT ON CHILDREN

In a letter this week to Shadow Children’s Minister Emma Lewell-Buck MP, Justice Minister Edward Argar MP announced that Charlie Taylor has been appointed to lead a review of the authorisation of pain-inducing restraint on children detained in young offender institutions and secure training centres, and during escort to these prisons and secure children’s homes.

The announcement comes days after we lodged our judicial review application with the High Court challenging the Government’s decision to allow escort officers working for the private contractor GEOAmey to inflict pain on children during their journeys to and from secure children’s homes. Staff working within secure children’s homes are prohibited from using such techniques, which Department for Education statutory guidance states can never be proportionate.

Article 39 is also challenging the lack of legal protection for children from being physically restrained simply to follow orders when they are under the control of escort officers, including when they attend hospital appointments or family funerals. The Court of Appeal has declared restraint for good order and discipline within secure training centres a breach of children’s right to protection from inhuman and degrading treatment or punishment.

Argar’s letter says the Chair of the Youth Justice Board “will bring excellent knowledge and experience after leading the Government’s comprehensive review of youth justice in 2016, and spending much of his career in various educational and behaviour management roles”.

Article 39’s Director, Carolyne Willow, states:

We are naturally delighted that there is a possibility that pain-inducing restraint of children could be removed from all custodial settings. Deliberately causing children mental and physical suffering has no professional place in education, health and social care environments, and we have consistently argued that children should have the same protection from violence wherever they are placed.

“Charlie Taylor leads an organisation which has historically stood isolated on this issue in not opposing pain-inducing restraint. From the appalling death of 14 year-old Adam Rickwood, who hanged himself after he was inflicted with a sharp blow to the nose – which was then an authorised restraint technique – onwards, the Youth Justice Board has traditionally failed to put its weight behind complete cultural change in custodial institutions. The YJB like many of those working within and around the penal estate have hitherto shown themselves incapable of seeing that children can be looked after without recourse to severe violence as a form of restraint. However, the organisation seems to be changing under Taylor’s leadership. His background in education could prove pivotal during this review since the culture and practice of schools working with children who have similar needs to those who end up in custody is markedly different from prisons. It would be fantastic for Taylor’s review to finally bring an end to the pain-inducing restraint of children.

“We don’t yet know the scope and timeframe of this review. It is over 14 years since Adam left behind a note saying he had asked officers what gave them the right to hit a child in the nose, and they said it was restraint. I have long given up on this being treated with any sense of urgency though, of course, every day that Ministers allow officers to deliberately hurt children is a day too long.”

In 2009, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment recommended the UK stop the use of pain-compliant restraint techniques in child prisons. The same recommendation has been made by the UN Torture Committee, the UN Committee on the Rights of the Child and the UK’s four Children’s Commissioners. Her Majesty’s Inspectorate of Prisons, the Association of Directors of Children, the NSPCC and parliament’s Joint Committee on Human Rights have similarly opposed the use of deliberate pain during the restraint of children.

Article 39 is represented by Dan Squires QC and Tamara Jaber from Matrix Chambers and Mark Scott from Bhatt Murphy Solicitors. Its legal challenge was only made possible through a crowdfunding appeal, which elicited nearly 200 donations.

Article 39 to set up national advocates network

In July 2018, Article 39 conducted an online survey of independent advocates in England. The findings give insight into their experiences, their workload and challenges, the groups of children they work with and what would help advocates give the best help to children and young people.

Article 39’s Assistant Director, Helen Donohoe, said:

“This survey reinforces our previous concerns that the provision of independent advocacy for vulnerable children and young people in England is inconsistent and disjointed. The results also show unequivocal support for a form of training from Article 39 and greater peer-to-peer connection and support. In response to that we will launch a nationwide advocates network in early 2019.”

Read the survey report here: Article 39 The 2018 survey of independent advocates.