'Excessive' use of face-down restraint in mental health hospitals

Demonstration of face-down restraint Medical director Tim Kendall in a demonstration of the technique

The government is considering a ban on the use of face-down restraint in English mental health hospitals.

The move follows figures which show the controversial technique being used hundreds of times a year in some trusts - a level described by a health minister as "shocking" and apparently "excessive".

Research by the mental health charity Mind finds that some mental health trusts no longer use face-down restraint because it is considered too dangerous and traumatic.

But figures obtained under the Freedom of Information Act reveal that two mental health trusts employ the procedure two or three times a day.

The Northumberland, Tyne and Wear trust used face-down restraint 923 times in 2011-12. Southern Health trust, based in Southampton, used it 810 times. Between them, the two institutions account for almost half of all the face-down restraint revealed in the figures.

However, a number of the 54 mental health trusts approached were not able to provide figures on restraint despite a statutory requirement to document and review every episode.

Health minister Norman Lamb has said he is "very interested" in "just banning face-down restraint".

Naomi Ball: "You're terrified anyway. It just makes you feel more scared"

"If that is possible, it should be done," he told the BBC. Mr Lamb has also ordered a "specific investigation" into the use of face-down restraint in Northumberland and Southampton.

"I want answers from them about their use of restraint and I want them to address what appears to be a very considerable excessive use of restraint."

In a statement, the Northumberland, Tyne and Wear NHS Foundation Trust said it only used the safest and most proportionate response when patients posed a risk to themselves or others.

"Due to the specialist nature of a number of our services such as our forensic services, the trust cares 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."

Southern Health NHS Foundation Trust said its staff were "trained to assess each situation and use the most appropriate form of restraint in each case".

The use of restraint

  • Healthcare staff have a duty of care to act in the patient's best interests
  • Nice guidelines state that when people in hospital for mental health care need to be controlled or restrained, this should only be done by trained staff
  • And restraint techniques should only be used "as a last resort, using minimum force and making sure that the person is safe"
  • Hospital policies typically say restraint will only be used if it is believed necessary to prevent harm to the person
  • Must be proportionate to the likelihood and seriousness of harm
  • Physical restraint involves one or more staff members holding or moving the person, or otherwise blocking their movement

"The restraint techniques we use are based on the best evidence available, and are designed to minimise discomfort and distress to patients and also to our staff."

Mental health service user Naomi Ball, from Dudley in the West Midlands, says she has endured physical restraint many times.

"It's totally dehumanising and degrading because all control has been taken away from you. You are pinned to the floor face down, you are terrified anyway, and it just makes you feel more scared," she said.

"You're supposed to be building up trust with the staff, but the way it's done quite often means that that trust is broken completely - and if you're scared and paranoid anyway it just feeds into that and makes it a lot worse."

The mental health charity Mind is calling upon government to "introduce an end to face-down physical restraint in all healthcare settings urgently".

In a report they say it is shocking that there have been 13 restraint-related deaths of people detained under the Mental Health Act since the death of David "Rocky" Bennett in 1998. Eight of those occurred in a single year (2011).

An independent inquiry found that Mr Bennett died as a direct result of prolonged face-down physical restraint and the amount of force used by staff at a medium secure mental health unit.

Tim Kendall experienced face-down restraint himself

"[It is] unacceptable that successive governments have neglected to take action, failed to establish national standards for the use of physical restraint in England and to introduce accredited training for healthcare staff," said Mind.

Among the English mental health trusts which have banned the use of face-down restraint is Sheffield Health and Social Care. Medical director Professor Tim Kendall is also a member of the committee currently reviewing NHS guidance on the use of restraint.

"We have taken a very determined step to stop using face-down restraint at the trust entirely and we haven't had any problems - none at all," Prof Kendall says.

"It has had a very positive effect and in fact has reduced our use of [other types of] restraint by 50-60%."

Most physical restraint 2011-12

Name of trust Times used

Source: Mind (6/54 trusts did not record this information)

Tees, Esk and Wear Valleys


Lancashire Care


Southern Health


Northumberland, Tyne and Wear


Birmingham and Solihull


North Staffordshire Combined


Cheshire and Wirral


Leeds and York Partnerships


5 Boroughs Partnership


Rotherham, Doncaster and South Humber


Mersey Care


Kent and Medway


Most face-down restraint 2011-12

Name of trust Times used

Source: Mind (27/54 trusts did not record this information)

Northumberland, Tyne and Wear


Southern Health


Oxford Health


Kent and Medway


Pennine Care


Dorset Healthcare University


Rotherham, Doncaster and South Humber


Somerset Partnership


South West Yorkshire Partnership


Black Country Partnership


North Staffordshire Combined


Cornwall Partnership


Cheshire and Wirral


Mark Easton Article written by Mark Easton Mark Easton Home editor

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  • rate this

    Comment number 373.

    Restraint can at times be absolutely necessary that is for sure but?

    When people in the streets fighting after having to much to drink or just simply being violent have more fundamental rights and protections, including repeat offenders, than those sectioned mental health you do have to question our countries archaic systems that punish the already venerable, yet allows others to reign free?

  • Comment number 372.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 371.

    Re: 369 Have your say Rejected.

    Quote: "There is another way..."
    Would you care to explain this other way.... that presumably works all the time, in every situation and with every type of patient - no matter the cause or state of their health problem at that time, and having total disregard for staffing levels & other patients/clients!

  • rate this

    Comment number 370.

    :Lets make load of Money lock people up!

  • rate this

    Comment number 369.

    For once I will defend the Gov. this has nothing to do with Gov. it is Mind research, a MH charity calling for this ban on face-down restraints. Which I agree with as I have spent several years using restraints which don't involve holding ppl face down. Anyone who says there is no other way has either never worked in the setting or only used C&R type restraints. There is another way...

  • rate this

    Comment number 368.

    It's all too easy to jump on the bandwagon and comment - even if you have never had any experience of working with very disturbed patients/clients. Restraint is sometimes necessary, the method used depends upon a number of factors, including staffing levels, number of available staff at time of incident & type of disturbance etc. Incidents need to be resolved quickly and safely for all concerned.

  • rate this

    Comment number 367.

    Same old rubbish from this ill informed and ideologically driven government. I work in education and you will probably see a u-turn when they possible get around to taking advice from people who work in the area rather than from a pressure group. Let those who want face down restraint banned, try dealing with mentally disturbed, violent people themselves and then see what they think.

  • rate this

    Comment number 366.

    I work within mental health services and have been trained in the use of safe restraint which includes face down restraint.While I understand the concerns about face down restraint I have to say I have experience in caring for patients who have expressed a preference for face down restraint,stating it is a more comfortable for them, requesting this be added to their care plan,person centred care.

  • rate this

    Comment number 365.

    Once again people who don't have to do the job making the job a whole lot harder.

  • rate this

    Comment number 364.

    Bad, ill thought out idea.
    Hats off to all who work in the mental health profession.

  • rate this

    Comment number 363.

    The video shows poor use of the restraint techniques so it is not to something to compare too. 3 members are required to take someone to the floor, one supporting the head and one on each arm. Also they already have locks on the "patient" so are in 'control' and do not need to take the person to the floor. Journalism looking for a story at the end of the day.

  • rate this

    Comment number 362.

    People who have been determined "unfit to stand trial" for example, are frequently sent to hospitals.

    I wonder if some of the nurses - poorly trained and full of tabloid bile - feel it incumbent upon themselves to dole out the punishment that the courts couldn't?

    There are few places where the brains/brawn question is more clear-cut than in a hospital environment.

  • rate this

    Comment number 361.


    You claim your post will explain why this restraint technique is necessary, then so not even attempt to do so...!!!

    All you have explained is why restraint per se is sometimes needed - very, very few people doubt that, most only having a problem with the use of this specific technique.....

  • rate this

    Comment number 360.

    The face down method of restraint...correctly applied by trained people ...is far less likely to cause injury to the person being restrained than attempts by several people to grab the wrist or collar...hold them in a head lock... put their arm up their back etc.The aim is always to first reassure the person that they can breath OK then make it clear they won't be allowed to move until calm down

  • rate this

    Comment number 359.

    Cameron need some of this treatment he spending money like he's had a break down.

  • rate this

    Comment number 358.

    Well said Ken B

  • rate this

    Comment number 357.

    Its funny people who make comments on Control and Restraint issues and techniques. People who look through rose tinted specs and who have never had to place an individual who may be violent under restraint. A person who is laid onto the floor in the prone position is less likely to cause them or staff injury. I believe that the Prison Service & NHS talk frequently about issues regarding restraint.

  • rate this

    Comment number 356.

    Perhaps those that make the rules should try doing the job !!

  • rate this

    Comment number 355.

    Michael Lloyd.some are criminals and opt for a mental health section as an alternative to prison and these people by nature are drug and alcohol users and can be very violent. So we need restraining techniques to keep control and keep all involved safe. Biting and spitting (HIV RISK) face down is the safest way until issue is resolved.

  • rate this

    Comment number 354.

    345. HYSR
    Also no one is asking for restraints to be banned, just face down restraints, which many believe can be dangerous and life threatening.
    All forms of restraint are dangerous and potentially life-threatening. Verbal deescalation is used more often than restraint.

    The real problem is that the safest restraint is 3 man team, but this requires funding which is sadly lacking.


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