Niamh’s Law

Niamh’s Law is named in memory of my beautiful friend Niamh, who passed away at the age of 21, on the 2nd of May 2026 whilst detained under the Mental Health Act.

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 or sustained in 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 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;
• where reasonably practicable, consultation with clinicians already involved in the patient’s care, particularly where the patient is under the care of specialist medical or psychiatric services; 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 needs, significant psychiatric risk, or potential risk of deterioration, relevant specialist advice should also be sought where reasonably practicable and, where this is not possible, as soon as reasonably practicable thereafter.

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.

Before transfer or admission takes place, the referring hospital, responsible clinical team, and receiving provider must take reasonable steps to satisfy themselves that the proposed placement is able to safely and reasonably meet the patient’s assessed physical-health, disability-related, accessibility, mobility, communication, personal-care, and medical needs.

Mental health providers must take reasonable steps to ensure that the environment in which a patient is detained is able to safely, reasonably, and consistently meet the patient’s physical-health, disability-related, accessibility, mobility, communication, personal-care, and medical 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.

Where concerns arise before or after admission that a placement cannot safely or reasonably meet the patient’s assessed needs, the referring hospital, responsible clinical team, receiving provider, and any relevant commissioning body must take reasonable steps to identify and secure a more suitable placement as soon as reasonably practicable.

The absence of immediately available alternatives must not remove the duty to actively seek a more suitable placement where the proposed or existing environment cannot adequately meet those needs.

Temporary workarounds, staffing arrangements, environmental adaptations, or care plans must not be treated as sufficient where they fail to provide a level of safety, accessibility, dignity, privacy, independence, or care broadly consistent with the patient’s assessed needs.

In determining whether a placement is suitable, providers must have regard to the patient’s dignity, privacy, independence, accessibility requirements, and ability to access essential personal care.

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.

Where a patient has known physical-health conditions, disabilities, neurological conditions, mobility impairments, chronic pain conditions, spinal cord injuries, or other medical vulnerabilities, reasonable steps must be taken to identify, assess, and document any additional risks associated with restrictive intervention and any adjustments necessary to reduce those risks.

Where reasonably practicable, patients with significant physical-health conditions or disabilities should have an individualised restrictive-intervention risk plan identifying known medical vulnerabilities, contraindicated positions or techniques, required adjustments, emergency risks, and preferred less restrictive alternatives.

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, where reasonably practicable, be adapted to minimise foreseeable risks arising from the patient’s physical-health condition, disability, or medical vulnerability.

Such interventions 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. Where emergency intervention is required, such input should be sought as soon as reasonably practicable thereafter.

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.

Where restrictive intervention results in injury, significant pain, physical deterioration, respiratory compromise, neurological symptoms, loss of function, or other adverse physical-health effects, appropriate medical assessment and clinical review must be arranged as soon as reasonably practicable.

In determining whether further restrictive intervention is appropriate, providers must take account of any adverse physical-health effects arising from previous interventions and consider whether additional safeguards, adjustments, or less restrictive alternatives are required.

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.

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.

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.