Long-time readers of the blog will remember the two high-profile cases of Seni Lewis and Kingsley Burrell, in London (2010) and Birmingham (2011) respectively. Both cases involved a fatal outcome after police officers were called to a mental health inpatient unit by NHS staff because of disorder and the result, after significant, disproportionate restraint in each case, was a tragedy leading to high-profile reputational damage beyond the most important thing, the tragedy for Seni, Kingsley and their families and friends.
Seni’s family, backed by their local MP Steve Reed and by the charity Inquest, campaigned for the introduction of what they called “Seni’s Law”, which lead to the Mental Health Units (Use of Force) Act 2018.
You can read more about the Act in another post, including the statutory guidance about its implementation by mental health trusts and police forces – the Act applies only in England.
Amongst other things, this Act required far better record keeping by NHS trusts about situations where force was used – not just force involving the police – and it would need to be reported. It took a few years after Royal Assent for the Act to come in to force and we have just learned the latest data, for 2022/23. The only requirement within the Act is for police officers attending mental health units to wear and activate their body worn video whilst attending and assisting staff, “where reasonably practicable”. The bulk of the Act relates to data gathering by NHS trusts about coercive interventions, including but not only those where the police are called.
EARLY DATA
The Guardian newspaper has provided coverage of some of this early data under the headline, “Black mental health patients more likely to be injured at the hands of police”. We know the police service is currently doing work on what is called the Police Race Action Plan and that mental health is a strand of work within this, so this data and the debate which surrounds it is important, not least towards public confidence in policing within the black community.
It’s worth noting here, the word ‘black’ is the word adopted in the Race Action Plan after all the normal consultations which goes with production of those things, including an independent oversight board and it is the word used within these statistics for those of us from those backgrounds variously described as “Black African, Black British, Black Caribbean, Black Other and Mixed Black backgrounds.”
- 2022/23
- Police officers used force on black inpatients in England 820 times resulting in 36 injuries.
- 4.4% of occasions where force was used.
- In same period, they used force towards non-black inpatients 6,244 times causing injury 406 times.
- 6.5% of occasions where force was used.
- 2021/22
- Police officers used force towards black patients 770 times resulting in 27 injuries.
- 3.5% of occasions.
- Force was used towards non-black patients 7,698, resulting in 559 injuries.
- 7.2% of occasions.
Statistics are always in need of untangling and you can use the Guardian’s quoted stastitcs to make any point you want —
- Use of force against black inpatients is rising – up from 770 to 820
- Percentage of occasions where force is used is leading to injury on more occasions – 3.5% to 4.4%
- Trends in the UoF are going in opposite directions for black and non-black patients – because UoF on non-black patients is reducing, from 7,698 to 6,244 and percentage of injury from 7.2% to 6.5%.
- That said, you can’t help but notice that non-black patients are injured more often than black patients are – in fact, 30% to 50% more often across each of the two featured years.
You can see further useful insight in to these statistics on the X-profile (formerly, Twitter) of Gavin Hales, senior research fellow and formerly of the Police Foundation. Gavin – who is well worth following if you like policing and statistics – has compared these figures with inpatient data from NHS England for black and white groups by looking at restraint per 1,000 admissions and injury per 1,000 admissions. Acknowledging there are problems putting together these two data sets, Gavin points out how much lower restraint and injury is per 1,000 admissions for black patients compared to white.
So there’s a lot here that we don’t know here and more data required.
CONTEXT IS MISSING
The above summary doesn’t tell us much in context, because there is no context offered. How many inpatients were there in these areas over that time; how many non-black patients were from other ethnic groups; how many occasions involved violence being used or threatened prior to the police being called and how serious was that violence; how many occasions involved restraint interventions by mental health services before things escalated to a point where the police were called? There are more questions, but this makes the point.
We can quite safely say some of this will have involved assaults on NHS staff and some will have involved patients being restrained by staff – some incidents will involve both and in both orders. But we also know that not all of it will have done. We also don’t know anything from the Guardian article about where restraint is happening – mental health trusts differ significantly in how they apply coercive interventions, how they are staffed and NHS data has shown this for years.
I recall one mental health trust having to publicly explain their restraint data because they were a significant outlier nationally for the number of restraint based interventions they applied to patients but their explanation was to essentially say “We’re one of the few trusts recording this correctly” and indeed, they were (and still are) one of just a few trusts nationally to be rated ‘outstanding’ by the Care Quality Commission.
ONGOING DISCUSSION
So this needs a lot more analysis than any newspaper will apply in a short article and what’s a touch frustrating, is that it’s obvious they have made a choice here to say black patients are more likely to be injured when they could have chosen to say the exact opposite thing and the numbers would bear them out.
- It is absolutely true from this data to say —
- “Black patients are more likely to be injured last year during restraint than black patients were during the previous year.”
- But it’s also true to say —
- Black patients are less likely to be injured during restraint than non-black patients.
- It’s also very valid to say —
- This data doesn’t tell us much about context or how prior disproportionality affects the impact of police-related restraint in mental health settings.
- We know the Mental Health Act 1983 is applied disproportionately by mental health services towards those of us who are black.
- 4% of the UK’s population is black; 9% of MHA admissions are black patients and this matters when analysing things which go on inside hospital, not just where policing becomes involved.
This Guardian piece is not analysis or coverage – it is a narrative at play and it’s both valid and invalid, all at the same time. It’s not invalid at all to point out some of the highlights offered by the numbers but to make a deliberate choice to say “more likely to be injured” by emphasising one aspect of the incomplete data when you could just as easily have said “less likely to be injured” by emphasising another part of it, shows some of what is going on here.
In reality, and subject to much better analysis of more than just this data, it paints a complex picture where should be concerned about how particular restraint techniques seem to be applied to black patients whilst at the same time being relieved to find they are less likely to be injured when restraint is undertaken. Is it paradoxical or ironic that is the case? – we won’t know unless there is more and better analysis which takes in to account about much more than policing and about much more than policing and mental health.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 