Manifesto
First Do No Harm are a user-led action group, formed of patients, parents, family, and friends of children who were, or are still, subjected to psychiatric inpatient services and associated iatrogenic harm. We connected in late 2022 in light of media reports into maltreatment at hospitals run by Active Care Group, formerly the Huntercombe Group. However, as we grow as an organisation, we have begun to realise the vast scope of the devastating flaws across all psychiatric services and institutions. What we have suffered at the hands of both private care providers and NHS hospitals cannot be undone, but we believe our voices and stories can be used to hold such services accountable, protect current and future patients, and spark wider change in the way mental ill health hospitals care for and provide treatment for their patients. This is our manifesto.
Our aims.
We have four overall aims that reflect the hopes, wants, and needs of First Do No Harm's members. We seek accountability and justice as well as action, as we believe each cannot occur without the other.
Accountability
Child and adolescent inpatient mental health services, and the agencies responsible for overseeing the care they provide, must acknowledge, thereby admitting to, the harm they have caused. We recognise that genuine improvement cannot be made without honesty and accountability. Services must actively listen to the stories of their previous (and current) patients and families in order to recognise patterns of systemic failings and abuse within their organisation. Services must then publicly acknowledge the systemic nature of maltreatment, neglect, coercion, and abuse incurred by their patients. The agencies responsible for overseeing the care provided by such services, namely the Care Quality Commission, ICBs who hold commissioning responsibilities, and wider NHS England, must acknowledge their role in enabling the harm of children and hold each other to account. The Department for Health and Social Care must hold inpatient services, NHS England and the Care Quality Commission to account if they fail to do so themselves.
Justice
Hundreds of thousands of young people have passed through the doors of psychiatric units across decades. Tragically, some of these young people do not return from their admissions and, at present, there is no specific documentation that outlines the number of deaths reasonably associated with their time in inpatient services. We recognise that these deaths are criminal, preventable acts committed by private providers and NHS services, who have ignored warning signs of malpractice, abuse, neglect, and closed cultures; therefore, we urge that corporate and individual criminal justice is served.
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Many of those who were admitted to inpatient facilities face serious long-term psychological and physical consequences as a result of what they suffered over the course of their time as a patient, including neurological conditions, trauma, and associated illnesses like P-TSD. Most of us will need therapeutic intervention for the rest of our lives. All of us have missed opportunities we may have had if it were not for our time spent in inpatient units; many of us have missed, and will continue to miss, education, careers, and independence. These services took our lives from us and will continue to take from us until the end of our days. We deserve the chance for a better future. Therefore, all mental health care providers should actively listen to the wants, needs, and wishes of the young people who were admitted to their services and engage with these young people to support their needs.
As a minimum, every single patient who has suffered at the hands of mental health providers should receive funding for weekly therapy sessions with a practitioner of their own choosing for a minimum of five years.
Action
Our action is threefold: campaigning, support, and closure.
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Campaigning: we’re lobbying for the closure of psychiatric inpatient services and for long-term reform in mental health care. We also promote alternatives to psychiatric treatment and network with stakeholders and charitable organisations where purpose and value align.
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Support: we provide resources, advice, signposting, and peer support to protect people who have been, or currently are, admitted to psychiatric inpatient hospitals. Similarly, we source other modes of support for those we support, such as solicitors to take legal action and charitable support or advocacy.
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Closure: through hosting a platform for creative outlet, we believe in sharing experiences without censorship to allow those harmed by mental health services the opportunity to heal. We also encourage those who we support to be as involved as possible in our campaigning to regain a sense of autonomy and power over their experiences.
Reform
We believe that, for meaningful change to be made, reform needs to happen by implementing robust accountability laws for mental health services, alongside vastly improving our understanding of mental ill health and acute distress. Vulnerable children are being admitted to inpatient hospitals under the guise that they will receive specialised treatment but, in reality, they are detained and housed at best, and neglected and abused at worst.
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There are few measures in place to protect young people from harm in psychiatric institutions, and we are failing those who so desperately need protection as a result. Both individuals and organisations are able to deflect accountability, primarily due to a lack of statutory legislation that holds them to account. CEOs of mental health organisations are able to leave failing services unscathed, without taking responsibility for their role in governance and protection of both staff and patients, to pursue similar, if not identical, careers. Psychiatric consultants frequently exploit the Mental Health Act, and inpatient facilities foster a culture wherein abuse of human rights are normalised and accepted. Professionals working within mental health services must be held to the same safeguarding standards, duty of care and criminal accountability as any other profession that works with vulnerable people.
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When private care organisations and NHS services are held to account by regulatory bodies, there is little execution of statutory powers to hold providers to account and prevent further harm. When serious failings occur, recommendations by non-statutory bodies are overlooked and lessons go unlearnt. Corporate accountability laws must be implemented and enforced to hold the NHS and private healthcare organisations criminally accountable for human rights abuses.
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Extensive action must be taken to ensure that the care young people receive in mental ill health hospitals is safe, individualised, kind, and effective. The changes that must be made to the provision of care are substantial, wide-ranging and indicative of the need for reform in the way that the UK understands, categorises and pathologizes mental illness; nonetheless, there are some key areas for improvement which can be focused on: placing emphasis on community-based, 'proactive' care rather than 'reactive' hospital admissions and psychiatric institutions, the elimination of restrictive practices; the elimination of the use of excessive psychotropic medication as treatment; the de-institutionalisation of mental healthcare services; the introduction of trauma-informed, proactive and holistic care at the heart of all services; and recognition of the prevalence of neurodiversity and sensory needs in the design of all services and treatment plans.