Face-down restraint ‘must end’, say campaigners


theweeksubThousands of people with mental health conditions every year are being restrained using a life-threatening technique, according to a new report.

The mental health charity Mind has discovered that more than 3,400 mental health patients across 27 NHS trusts were pinned face-down on the floor by staff in 2011-12, despite the increased risk of death from using that form of restraint.

Half of the incidents took place in just two trusts, Northumberland, Tyne and Wear NHS Foundation Trust (923 incidents) and Southern Health NHS Foundation Trust (810 incidents), even though four mental health trusts no longer use face-down restraint at all.

There have been at least 13 restraint-related deaths of people detained under the Mental Health Act in England since 2000, eight of which were in 2011.

The survey of mental health trusts in England – using Freedom of Information Act requests – found a “staggering variation” in the use of all kinds of physical restraint, from 38 incidents at one trust to more than 3,300 at another, despite the fact that it is supposed to be used as a last resort.

There were almost 40,000 incidents of physical restraint across 47 trusts, with nearly 1,000 injuries to mental health service-users reported by the 34 trusts that responded to that question, with the worst offender reporting 421 injuries and the lowest 0 (in five trusts).

The report says some trusts have a “shameful over-reliance on physical restraint and use face down physical restraint too readily in their response to managing a crisis situation”.

There was also a huge variation in the number of times trusts used restraint to administer medication, with one trust reporting 592 incidents, and another just one.

Mind also surveyed 375 frontline healthcare staff involved in physically restraining service-users, and found nearly a quarter (22 per cent) had not had face-to-face training on physical restraint techniques in the last year.

Jessica*, from south London, was repeatedly restrained during the seven years she spent in various hospitals in her early 20s.

In some of them she was not restrained at all, while in others she had “horrific” experiences. She was restrained – by up to 10 staff members at a time from different wards – because she self-harmed and had suicidal thoughts.

She said people were “at their most vulnerable and at their most not believed” at such times, and added: “A lot of times in hospital people are treated a bit more like animals than people.

“You can’t have people dying [through restraint]in 21st century Britain. It’s horrendous.”

She said mental health trusts must change their “training culture”, and show more respect to patients.

“So many people, trained psychiatric nurses, were trained years ago or in another country where they were taught bad practice.”

She added: “I had some bad experiences of being restrained face down with my face pushed into a pillow.

“I can’t begin to describe how scary it was, not being able to signal, communicate, breathe or speak. Anything you do to try to communicate, they put more pressure on you.”

She was restrained on a daily basis for three years. Now she finds it difficult to let anyone touch her, even friends or family members.

Jessica said she did not believe standards had improved since her last experience in about 2010.

A close friend witnessed patient after patient being restrained when she was in a local psychiatric unit, while “the whole atmosphere was one of violence”.

In the end her friend’s mother decided to quit her job to care for her daughter herself.

Mind said it wanted to see national standards on the use of physical restraint, accredited training in managing violence for frontline healthcare staff, and standardised recording of every incident of restraint.

Paul Farmer, Mind’s chief executive, said: “Physical restraint can be humiliating, dangerous and even life-threatening and the huge variation in its use indicates that some trusts are using it too quickly.

“Face down restraint, when a person is pinned face-down on the floor, is particularly dangerous, as well as extremely frightening to the person being restrained. It has no place in modern healthcare and its use must be ended.”

Mind said that recommendations made by the inquiry into the death in 1998 of David ‘Rocky’ Bennett have still not been implemented.

He died in a medium-secure mental health unit, as a direct result of force used during prolonged face-down physical restraint used by five members of staff. An inquiry in 2004 found there was a significant risk of death from such restraint.

Norman Lamb, the Liberal Democrat care and support minister, said he was concerned at the wide variations in the use of restraint shown by the Mind research.

He said: “I will be asking for an explanation from the two trusts with the highest use of face down restraint as to what they are doing to improve the situation and learn from trusts with similar services who have minimised the use of restraint/face-down restraint.”

He said the Department of Health would publish new guidance on restraint and de-escalation techniques later this year.

Northumberland, Tyne and Wear NHS Foundation Trust said its figures for face-down restraint were “comparable to other mental health trusts of similar size”, while it provided services for “some of the most complex and challenging patients from all over the country, which means that the figures may be higher when comparing to areas without such specialist services”.

A trust spokeswoman said “no restraint was without risk” and face-down restraint was only used “in the very last resort after everything else has been exhausted”, while the technique was “in line with best practice and national guidance” and was used by “the vast majority of trusts”.

But she refused to say whether the trust was confident that it did not need to review its policy on face-down restraint.

Southern Health NHS Foundation Trust said that it was “one of the largest providers of mental health and learning disability services in the country” and provided “highly specialised services for people from across the whole country” with “highly complex and challenging needs”.

A trust spokesman said face-down restraint was “one of a number of methods of restraint that we use, all of which are evidence-based and designed to be as safe as possible”, while it was “only used in the most urgent cases”.

He added: “We are constantly reviewing our use of prone [face-down] restraint across our services and will continue to do so in the future and in light of any new evidence.”

Meanwhile, a new report from the constabulary and prisons inspectorates, the Care Quality Commission and the Healthcare Inspectorate Wales has called for far fewer people with mental health conditions to be detained in police custody.

Police have powers to take someone experiencing mental health distress in public to a “place of safety” so they can be medically assessed, but this should only be a police cell in “exceptional” circumstances.

In 2011-12, more than 9,000 people were taken into police custody using these powers – often because of a lack of staff or beds at a health-based place of safety. Some of them were as young as 14, and each person spent on average more than 10 hours in a cell.

In more than 80 per cent of the 70 cases examined in detail for the report, the person had either attempted suicide or self-harm, or said they were thinking of doing so.

*Not her real name

20 June 2013