Image: Olaseni Lewis.
Olaseni Lewis died after being restrained by police officers in a mental health hospital. An inquest found that “excessive, disproportionate and unreasonable force” was used.
In response, Seni’s Law – hard fought for by his family – passed into law earlier this month. Seni’s Law requires hospitals to collect and publish data on how and when physical force is used. It also led the Minister Jackie Doyle Price to make commitments to consider the issue of the lack of independent investigations into deaths in mental health settings.
But the law, although a step in the right direction in reducing the number of deaths in mental health hospitals and units, won’t address or resolve deeper-seated issues in mental health care. Why is it that so many people going through mental health crises are met with force by the police in the first place, and why are so many of those who are, black? Why do so many with mental health problems end up in police cells and even prisons rather than hospitals? And what can we - as citizens, and as health professionals, do about it?
The death of Olaseni Lewis
On the 31st of October 2010, 23-year-old Olaseni Lewis admitted himself into Bethlem Royal Hospital in Beckenham for mental health treatment. He had previously not displayed signs of mental illness, but on the evening of 29th October, his family and friends noted he was flitting between calm and agitated states.
In hospital, shortly after his family left, Lewis became agitated and staff called the police in order to restrain him. Eleven police officers restrained him using what was later deemed to be “excessive force”, leading to his airways becoming blocked. Lewis fell unconscious and was transferred to another hospital. He was later pronounced dead.
An inquest into Lewis’ death in 2017 found that a number of failings by police officers contributed to his death, stating that: "The excessive force, pain compliance techniques and multiple mechanical restraints were disproportionate and unreasonable.”
Deaths in police custody and mental health crises
Olaseni Lewis is not the first (and without significant policy changes, won’t be the last) to die as a result of police restraint while going through a mental health crisis.
Sean Rigg, a 40-year-old musician who suffered from paranoid schizophrenia died at the entrance of Brixton police station, South London, on the 21st of August 2008. After members of the public called the police due to Rigg’s “strange behaviour”, four police officers attended, restraining him; Rigg’s mental and physical health subsequently seriously deteriorated. After accusing Rigg of “faking unconsciousness”, a doctor called to the scene found that his heart had stopped. He was later pronounced dead.
Similarly, Thomas Orchard, a 32-year-old man with paranoid schizophrenia, died in hospital seven days after being taken to Heavitree Road police station in Exeter, Devon, in October 2012. During detention, Orchard had a so-called ‘Emergency Response Belt’ placed across his face; he was left lying motionless in a locked cell for twelve minutes before staff re-entered and began CPR.
More recently, Kevin Clarke, a 35-year-old black man, came into contact with police in Lewisham, South London on 9 March 2018 while going through a mental health crisis. He was restrained by police officers and “became unwell”, and was later pronounced dead.
These are more than individual cases; people with mental ill health are more likely to die after police contact. Nearly three quarters of those who died during or following contact with the police were reported to have mental health concerns, according to an Independent Office of Police Complaints (IOPC) report from 2017-18.
Mental health and prisons
Those who suffer from mental health problems are also disproportionately likely to come into contact with the criminal justice system and end up in prison. Nearly two out of five people detained in police custody have some form of mental health problem, and over nine out of ten prisoners are believed to have experienced one of the following according to NICE estimates from 2014: psychosis; anxiety or depression; personality disorder; alcohol abuse; and/ or, drug dependence.
A staggering 76% of prisoners have two or more mental health problems, according to NICE - so common as to be considered the norm. It is estimated that 14% of women serving prison sentences, and 7% of men (and 10% of male remand prisoners) have experienced psychosis, as compared to 0.5% of the general population.
Worryingly, 26% of women and 16% of men said they had received support for a mental health problem in the year prior to their custody.
Race, mental health and the criminal justice system
And what part does race play in all this?
African Caribbean communities in the UK were 50% more likely to be referred to mental health services via the police than their white counterparts, according to Black Mental Health UK in evidence given to the Home Affairs Select Committee in 2013. Considering that fact that mental health service users make up half of those who die after police contact it is clear that black mental health service users face a disproportionate risk of death.
BAME people are also disproportionately likely to die in police custody or after contact with the police in general, with the deaths of BAME people constituting 14% of all deaths between 1990-2017 according to the charity INQUEST.
Not only do black people face more violence from the police, they are also hugely over-represented in the figures of those diagnosed with severe mental health problems. Black people in the UK are three to five times more likely to be diagnosed and admitted with schizophrenia, and currently are four times more likely than their white counterparts to be detained under the Mental Health Act. While there is no single explanation for this disproportionality, Dr Suman Fernando amongst many others – a well-known psychiatrist and professor – claim that people from BAME backgrounds are pathologised, due to reasons such as unconscious prejudices amongst practitioners, and barriers and distrust in seeking mental health care prior to crisis. BAME people are also more likely to experience poorer outcomes from mental health treatment.
Racism and pathologism
The intervention of carceral and surveillance practices into mental health services, and into the UK’s treatment of those with mental health problems, means that those on the sharp edge of institutional and systemic racism suffer. As Colin King, an activist and founder of the Black and Asian Coaches Association, wrote of his experiences with mental health services: “They told me I was dangerous, unpredictable, dysfunctional, and angry. I felt I had become a caricature to a legislation that repressed me and criminalised me.”
The relationship between psychiatry and biological racism was used for centuries to justify the dehumanisation of African communities alongside indigenous peoples during Europe’s colonial endeavours. Some mental health practitioners have pointed to this history when attempting to understand current disparities in treatment and racial prejudices within psychiatry.
However, current government policies also serve to entrench the pathologism - and criminalisation - of BAME communities. The so-called ‘Gangs Matrix’ - a much-criticised gang-mapping database launched by the Metropolitan Police Service in 2012 and shared with other agencies and services - is one example of this. The Prevent duty - a strand of counter-terror policy that requires public sector workers to have “due regard to the need to prevent people from being drawn into terrorism” - has also been criticised as targeting and pathologising Muslim communities. Both create and operate under a ‘pre-criminal space’, encouraging the surveillance and reporting of those who practitioners believe may be susceptible to committing violent acts.
These policies permeate into health and welfare services, and thus into the relationship between patient and healthcare worker. Many NHS mental health trusts blanket screen all patients for signs of susceptibility to radicalisation, according to damning research published by academics at the University of Warwick - something that mental health practitioners have been particularly concerned about. Certain communities are treated with blanket suspicion, and this in turn results in the exclusion, surveillance and policing of these communities.
Cuts to mental health services
There are various reasons to explain the factors that are pushing people with mental health problems toward the criminal justice system – police custody and prisons – rather than to mental health services. One is a criminal justice system in the UK that does not focus on rehabilitation and meeting the various complex needs of those, particularly the large number of people with mental health problems, serving sentences in prisons – but instead on punishment. Many opportunities are missed by the police and courts to divert people with mental health problems away from imprisonment toward instead “effective treatment in the community”, according to a report by the Centre for Mental Health. Little is being done to identify and address the socio-economic problems that those who go on to serve prison sentences face prior to their imprisonment.
Related to this is of course cuts to mental health services. With funding for mental health hospitals reduced by £105 million by 2017 as compared to 2012, the BMA community care committee chair Gary Wannan accused the government of “chronic underfunding of mental health services [that] has left some of the most vulnerable people in society without the care and support that they desperately need.”
The passing of Seni’s Law is a step forward in reducing the physical violence with which mental health patients in times of crisis are met by police officers and hospital staff. It is a further step toward accountability for the use of dangerous and sometimes fatal physical restraint.
More is needed. While there are undoubtedly situations in which police officers are needed in hospitals for the safety of staff and patients, currently the close relationship between policing, enforcement and healthcare provision is putting patients at risk. We must have a health system, and in particular well-funded mental health services, that are separated from enforcement. No one should end up in a police cell while going through a mental health crisis. When an ambulance is called for someone going through a crisis, the police should not be first respondents.
Given the figures of those with several mental health problems serving prison sentences, and the racial disproportionality in terms of responses to mental health crisis calls, at Medact we believe that the government should be investing in restorative and supportive approaches to mental health. Our current approach to mental health is one that is more likely to lead to a person to come into contact with the criminal justice system than with mental health services. We urgently need to break this punitive cycle.
Health services and politicians must begin to reformulate our ideas - and policies - around public health and security. Is a society in which our prisons are full of people with mental health problems and addiction problems a healthy society? The Health Impacts (Public Sector Duty) Bill 2017-19 - spearheaded by the former Shadow Secretary for Mental Health, Luciana Berger MP - advocates for a holistic understanding of the socio-economic determinants of health, and thus proposes a shift in how we understand ‘health policy’.
Berger’s bill seek to centre public health in all policies, such as immigration, housing, welfare, town planning and policing. If this government is truly concerned with addressing rising levels of mental ill-health, this Bill should be discussed in depth in Parliament and made into law. It could be the starting point of redefining the values and priorities that guide the provision of public services in England - with a well-known success of this kind of ‘public health approach’ evident in Glasgow, where knife crime was significantly reduced using a holistic and rehabilitative rather than punitive model.
For health professionals who see patients daily who face structural racism, who are in debt and living in precarious housing situations - who seek to do more to address these socio-economic issues that impact health - I would encourage them to get involved with Medact. And it is important that health professionals show solidarity with those who are met with force instead of care by police, prison or immigration officers, by supporting the family campaigns seeking justice and accountability. Health professionals should be attending the United Families and Friends Campaign annual vigil and march for those who have lost their lives in police, prison and psychiatric custody - held on the last Saturday of each October.
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