Niamh’s Law

Niamh’s Law is named in memory of my friend Niamh, who died aged 21 while detained under the Mental Health Act, on the 2nd of May 2026.

Niamh was a wheelchair user living with a spinal cord injury and complex medical needs. Her experiences in psychiatric detention highlighted concerns around accessibility, dignity, continuity of care, and the protection of physically vulnerable patients within mental health settings.

Niamh’s Law would establish clearer duties around:

• physical-health protection,
• accessible and suitable placement,
• continuity of essential treatment,
• safer restrictive practice,
• staff training,
• and recognition of physical deterioration.

Psychiatric inpatient environments are often designed primarily around behavioural and mental-health management. Patients with significant physical-health conditions may therefore face additional risks where wards are not adequately equipped, accessible, or trained to meet complex medical or disability-related needs.

Although existing law and guidance contain general protections, these duties are spread across different frameworks and can be inconsistent in practice. There is no clear or unified safeguard requiring psychiatric services to identify and actively manage the physical-health risks created by detention itself.

This can lead to:

physical symptoms being mistaken for psychiatric distress,
delayed medical assessment or treatment,
unsafe restraint practices involving physically vulnerable patients,
interruption or withdrawal of essential treatment,
inadequate accessibility, equipment, or mobility support,
lack of specialist consultation where complex physical-health risks are involved,
and preventable physical deterioration, injury or distress.

Niamh’s Law would create a clearer safeguarding framework specifically focused on protecting physical health during psychiatric detention. It would not prevent necessary psychiatric care or emergency intervention, but would require physical-health and disability-related risks to be recognised, documented, and properly considered. 

The proposal is intended to apply specifically to detained psychiatric patients whose physical-health conditions or disabilities create additional risks during detention, restrictive intervention, treatment disruption, or inpatient care.

PROPOSALS 

1.Mandatory Physical-Health and Disability Risk Plans

A documented physical-health and disability risk plan should be completed within 48 hours of admission for detained patients with significant physical-health or disability-related needs.

The patient’s responsible clinical team must ensure the assessment is completed with input from appropriate healthcare professionals where reasonably practicable.

The plan should include consideration of, where appropriate:

pain management,
medication continuity,
mobility and transfer needs,
bowel and bladder care,
pressure sore prevention,
respiratory needs,
seizure management,
accessibility requirements,
communication needs,
emergency medical risks,
and any other clinically relevant physical-health or disability-related needs.

2. Continuity of Essential treatment for Patients with Significant Physical-Health Needs

For detained patients with significant physical-health conditions, disabilities, neurological conditions, chronic illnesses, spinal cord injuries, chronic pain conditions, or other complex medical needs, essential physical-health and psychiatric treatment should not be significantly altered, interrupted, withheld, or withdrawn without:

review by an appropriately qualified clinician,
consideration of the risks associated with treatment disruption,
and, where reasonably practicable, consultation with a second medical professional independent of the original decision-maker.

Where treatment changes relate to complex physical-health conditions or potential medical risk, relevant specialist advice should be sought where reasonably practicable.

This includes consideration of:

long-term pain medication,
psychiatric medication,
bowel and bladder care,
seizure medication,
respiratory support,
cardiac-related treatment considerations,
mobility assistance,
physiotherapy,
and other clinically necessary treatment.

Where a patient is already under the care of a relevant specialist, reasonable efforts should be made to consult that specialist before significant treatment changes are made.

Nothing in this section prevents immediate treatment decisions where urgently necessary to prevent serious harm to the patient or others.Where emergency treatment changes are made, the decision and clinical reasoning should be reviewed and documented as soon as reasonably practicable thereafter.

3. Safe, Suitable, and Accessible Care Environments

Patients with significant physical-health needs or disabilities should only be detained in environments able to safely and reasonably meet those needs.

Mental health providers should ensure access to:

suitable accessible facilities,
appropriate medical and mobility equipment,
accessible washing and toilet facilities,
safe transfer procedures,
necessary staffing support,
pressure-relief equipment,
and continuity of essential physical care.

Patients should not be deprived of necessary accessibility aids, mobility equipment, or disability-related support without clear clinical justification.

Where a psychiatric setting cannot safely meet a patient’s needs, alternative placement arrangements must be considered.

4. Physical-Health Protections During Restrictive Practice

Before restraint, seclusion, rapid tranquillisation, or forced transfer is used, staff should consider whether physical-health conditions or disabilities increase the risk of harm.

Restrictive interventions involving physically vulnerable patients should include consideration of:

respiratory safety,
positioning,
spinal and neurological risks,
pain impact,
mobility limitations,
and less restrictive alternatives.

Where reasonably practicable, staff should seek input from clinicians familiar with the patient’s physical-health needs.

Following restraint, seclusion, rapid tranquillisation, or other restrictive intervention involving a patient covered by this Act, reasonable steps should be taken to assess and monitor for physical injury, medical deterioration, respiratory compromise, pain escalation, or other adverse physical-health effects.

5. Equal Recognition of Physical Health Needs

Where a detained patient presents with pain, physical symptoms, deterioration, or medical distress, these concerns must first be treated as potential physical-health issues and given appropriate medical assessment and attention.

Physical symptoms must not automatically be assumed to be psychiatric or behavioural in origin without appropriate investigation.

Detained psychiatric patients should remain entitled to physical-health assessment, treatment, and emergency care equivalent to that available in other healthcare settings.

6. Training and Safer Practice

Mental health staff involved in restrictive interventions should receive training on:

disability awareness,
physical-health risks during restraint,
safe positioning,
chronic pain conditions,
spinal and neurological conditions,
mobility-related risks,
pressure injury prevention,
and reasonable adjustments under the Equality Act 2010.
Training should support safer, trauma-informed, and physically informed approaches to restrictive practice.

7. Patient Involvement and Communication

Where reasonably practicable, detained patients with significant physical-health needs or disabilities should be involved in decisions relating to:

physical-health management,
accessibility needs,
restrictive interventions,
mobility support,
communication needs,
and essential treatment.
Staff should take reasonable steps to consider the patient’s known medical history, established care needs, existing specialist advice, and any communication or accessibility difficulties that may affect care or safety.