Olanseni Lewis, a 23-year-old black student from south London, was admitted as a voluntary patient to the Bethlem Royal Hospital (South London and Maudsley NHS Trust, SLaM) on 31 August. Within hours of admission up to seven police officers had restrained him — he struggled to breathe and was transferred to Croydon University Hospital, and was later pronounced dead on 4 September. SLaM and the Independent Police Complaints Commission have launched an inquiry.
Restraint by healthcare workers is — in theory — informed by strict guidelines and training, intended to see physical intervention as a last resort, with patient dignity paramount. Its use is sometimes necessary to protect workers and other service users from violence, but comes with high risks of positional asphyxia (when the airway is blocked due to face-down restraint) or excited delirium (when a person struggles past the point of fatal exhaustion). It also leads to feelings of humiliation and shame for the service user involved.
Concerns are growing that physical intervention is becoming more common — and some NHS trusts still practice pain compliance where service users are subjected to having their joints bent to the point before breakage to encourage passivity.
Lewis’s death emphasises a worrying correlation between ethnicity, psychiatric intervention and restraint. 2009 National Patient Safety Agency statistics show people from African Caribbean communities are 44% more likely to be sectioned under the Mental Health Act and are more likely to be misdiagnosed, over-medicated and restrained once in care. The high-profile 1998 inquiry into the death of David Bennett (a 38-year-old black service-user in Norwich) during restraint by healthcare workers reported institutional racism within mental health services.
Lewis’s death highlights a growing concern about the impact of police involvement on this situation. Police restraint lacks the safeguards of that by healthcare workers — involving handcuffs, batons, and police officers lying across service users. In recent years several young black men have died during police restraint in relation to psychiatric services — among others, Roger Sylvester died in Haringey in 1999 and Sean Rigg in Brixton in 2008. On the same day as Lewis’s death Colin Holt, a black 52-year-old sectioned patient at Medway Maritime Hospital in Gillingham, died during police restraint at his home.
Some reports of Lewis’s death have described police involvement as “normal practice”, yet SLaM guidelines suggest only involving the police if the service user has a weapon or others are seriously hurt or threatened. Reports have also emerged that workers pleaded with the police to let Lewis go as he struggled to breathe, and that they have described the restraint as “violent”.
There is perhaps a developing culture in acute services of police involvement as workers don’t have the resources, training or staffing levels to deal with violent incidents, and staff support following incidents is rarely sufficient.
These problems will only be exacerbated as the impending cuts are rolled out. SLaM has already announced £3.7m of cuts, with plans to “move responsibility for health and well-being back to individuals”.
If therapeutic services and jobs are cut, violence will inevitably increase. Boredom, a lack of structured activity, and frustration at staff having no time to listen to and talk with service users are key factors in increasing violence.
When violent incidents do occur lower staffing levels will mean workers are forced to call upon police intervention. This will lead to mental health services that are less therapeutic and more punitive and distressing for both service users and workers.