Niamh’s Law

Niamh’s Law is named in memory of my beautiful friend Niamh.

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 must not be significantly altered, interrupted, withheld, reduced, or withdrawn unless the decision is clinically justified, proportionate, and consistent with the patient’s overall safety and wellbeing.

Mental health providers must ensure that physical-health needs and psychiatric needs are considered together and not managed in isolation where treatment changes may create foreseeable risk of physical deterioration, psychiatric deterioration, distress, loss of function, medical instability, or preventable harm.

Any significant change to either physical-health or psychiatric treatment must include:

• review by an appropriately qualified clinician,
• consideration of the risks associated with treatment disruption,
• documented consideration of the risks associated with treatment disruption or alteration,
• consideration of interactions between physical-health and psychiatric conditions,
• consideration of the patient’s established medical history, existing treatment arrangements, and known care needs,
• and, where reasonably practicable, and where this is not possible, as soon as reasonably practicable thereafter, consultation with a second medical professional independent of the original decision-maker.

Where treatment decisions involve complex medical conditions, disability-related care, significant psychiatric risk, or potential risk of deterioration, relevant specialist advice should be sought where reasonably practicable.

Reasonable efforts should be made to consult clinicians already involved in the patient’s care before significant treatment changes are made, particularly where the patient is under the care of specialist medical or psychiatric services.

This section applies to, but is not limited to:

• psychiatric medication,
• long-term pain medication,
• bowel and bladder management,
• respiratory support,
• cardiac-related treatment,
• seizure-related treatment,
• mobility and transfer support,
• physiotherapy and rehabilitation,
• accessibility-related support,
• and any other clinically necessary treatment or care arrangement.

Treatment must not be significantly altered solely on the basis of psychiatric detention, behavioural presentation, assumptions regarding capacity or credibility, diagnostic overshadowing, perceived non-compliance, or the absence of immediate specialist availability without appropriate assessment and documented clinical justification.

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 required, the decision, clinical reasoning, and subsequent review must be documented as soon as reasonably practicable.

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, forced transfer, or other restrictive intervention is used, staff must consider whether a patient’s physical-health condition, disability, or medical vulnerability increases the risk of harm.

Mental health providers must ensure that all staff involved in restrictive interventions receive mandatory and regularly updated training on the additional risks faced by detained patients with significant physical-health conditions or disabilities.

This training must form part of mandatory restraint, use-of-force, patient-safety, and safeguarding training requirements and should be delivered in accordance with national standards, restraint-reduction principles, and best-practice guidance.

Training under this section should include, where relevant:

• disability awareness and reasonable adjustments,
• respiratory safety and positional asphyxia risks,
• safe positioning during restraint,
• spinal cord injury and neurological risk,
• chronic pain conditions,
• mobility limitations and transfer safety,
• seizure disorders and autonomic risk,
• pressure injury and circulation risks,
• recognition of physical deterioration,
• trauma-informed approaches,
• communication and accessibility needs,
• de-escalation techniques,
• and less restrictive alternatives to intervention.

Restrictive interventions involving physically vulnerable patients must include consideration of:

• respiratory safety and associated risks,
• positioning,
• spinal and neurological risks,
• pain impact,
• mobility limitations,
• existing medical conditions,
• and less restrictive alternatives.

Where reasonably practicable, staff should seek input from clinicians familiar with the patient’s physical-health needs before restrictive intervention is carried out.

Following restraint, seclusion, rapid tranquillisation, forced transfer, or other restrictive intervention involving a patient covered by this Act, reasonable steps must be taken to assess and monitor for:

• physical injury,
• medical deterioration,
• respiratory compromise,
• pain escalation,
• neurological complications,
• and any other adverse physical-health effects.

Training and practice requirements under this section should complement existing duties and standards under:

• the Mental Health Units (Use of Force) Act 2018,
• the Mental Health Act 1983,
• the Equality Act 2010,
• relevant NHS restraint-reduction guidance,
• safeguarding obligations,
• and applicable NICE guidance relating to violence, aggression, restrictive practice, and patient safety.

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 provided with appropriate medical assessment, investigation, and attention.

Each presentation of pain, physical symptoms, deterioration, or medical distress must be assessed on its own clinical merits. Previous psychiatric history, behavioural presentation, functional symptoms, self-harm history, or prior diagnostic formulations must not be used as the sole basis for attributing new or worsening symptoms to psychiatric, behavioural, exaggerated, fabricated, self-induced, functional, or factitious causes without appropriate assessment and supporting clinical evidence.

Physical symptoms must not automatically be dismissed, minimised, or deprioritised on the basis of psychiatric detention or mental-health diagnosis alone.

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

6. 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.