'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 5.

    As an ex psych nurse in the special hospital system, face down restraint led to fewer injuries for all. Having been bitten, spat at, punched, head butted, kicked, hair pulled etc, this proposed ban is nothing short of ridiculous and echoes the normal system whereby those who don't have to actually deal with the harsh realities tell those who do how to do it. It is madness. Spend a shift or two 1st

  • rate this

    Comment number 3.

    mmmm I'd like to see all the people complaining about this try and restrain a 15st mental patient.
    Better training yes. Knee jerk reactions with politically correct overtones. No.

  • rate this

    Comment number 12.

    Well, what are the other options?

    Do we potentially put members of staff at risk of harm and injury because we try to use another technique? It's all very well the Health Minister criticising the PCT's, but what does he actually know about it? Has he ever dealt with a violent, deranged person? How would he approach it?

    BTW, I'm a Custody Sergeant. A nice one.

  • rate this

    Comment number 20.

    I have been a long term patient in a low security hospital. The problem is not due to the type of restraint used, it is the person using it. I have seen it used correctly, and I have seen it used as a bullying/revenge tactic against an obnoxious, but not aggressive, patient.

  • rate this

    Comment number 9.

    I advocated face down restraint on many clinically appropriate occasions with violent patients. It kept paints safe, it kept staff safe, it kept visitors safe. On some occasions, with severely challenging patients, it is the last and best resort and needs to be retained.

    Love to see the PC dogooders try and cope on an under staffed ward without it...injuries and abuse would escalate horrifically.


Comments 5 of 373



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