Mind logoMental health charity Mind has called for the government and NHS England to put an end to life-threatening face down restraint of people with mental ill health in healthcare settings.

Data secured by Mind under the Freedom of Information Act found that at least 3,439 patients in England were restrained in a face down position in 2011-12, despite the increased risk of death from this kind of restraint.

Half of all incidences of face-down restraint occurred in just two mental health trusts: Northumberland, Tyne and Wear NHS Foundation Trust and Southern Health NHS Foundation Trust.

Variation in use of restraint

Meanwhile, two others - Hertfordshire Partnership University NHS Foundation Trust and Sheffield Health and Social Care NHS Foundation Trust - have abolished the use of face-down restraint.

This is indicative of the national picture, where there are huge variations between mental health trusts in the use of all types of restraint. There were at least 39,883 recorded incidents of all kinds of physical restraint in 2011-12, resulting in at least 949 injuries to people with mental ill health, according to Mind.

However, Surrey and Borders NHS Foundation Trust reported just 38 incidents over the year while Tees, Esk and Wear Valleys NHS Foundation Trust reported 3,346, despite the fact that physical restraint is supposed to be used as a last resort.

Mind also surveyed 375 frontline healthcare staff involved in physically restraining people with mental health problems and found that 9% said that the last time they were involved in physically restraining someone they didn’t feel they knew what they were doing.

More than 4 in 10 (42%) said that, with hindsight, they feel restraint has sometimes been used inappropriately.

The survey also found that using restraint is part of daily practice for some healthcare professionals: some said they used it more than 100 times in the last 12 months and others admitted that they use it every shift.

Paul Farmer, chief executive of Mind, 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. Our research shows that some trusts have a shameful overreliance on physical restraint and use face-down physical restraint too readily in their response to managing a crisis situation.

“We know that healthcare staff do a challenging job and sometimes need to make difficult decisions very quickly, but physical restraint should only be used as the last resort, when there’s no other way of stopping someone from doing themselves or others immediate harm. There is never an excuse for face down restraint.

“When someone’s life comes crashing down in a crisis they need help, not harm. They may be frustrated, frightened and extremely distressed but even when they seem aggressive and threatening, or refuse treatment, they still desperately need help and compassion.”

Mind wants national standards on the use of restraint to be introduced, as well as accredited training and an end to face-down restraint.

In response, a statement from Northumberland, Tyne and Wear NHS Foundation Trust said that the types of restraint techniques that its staff practice are used by the vast majority of mental health and disability NHS trusts and are in line with current best practice and national guidance.

“Our staff are given extensive training in recognition, prevention and de-escalation skills as well as methods of physical restraint and the risks associated with the use of physical restraint to ensure that they can manage episodes of violence and aggression in a safe, supportive, dignified and professional manner in line with national guidance and the best available evidence. 

“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.”

Lesley Stevens, clinical director of mental health services at Southern Health NHS Foundation Trust, said: “We are committed to maintaining the safety and dignity of everyone who uses our services, the vast majority of whom will never experience restraint. However, as a last resort, restraint is sometimes necessary when there is an immediate and serious risk to people’s safety.

“We welcome Mind’s report into the use of restraint in mental health services, and hope that it will contribute towards more robust national guidance in the future. We fully recognise that, whatever methods are used, there is no completely safe restraint position or duration.

“Our staff are trained to understand the triggers which can lead to aggression so they can act early to avoid the need for physical restraint. They are also trained how and when to use physical restraint in the safest possible way, and for the shortest possible time, when it does become absolutely necessary.

“Whenever restraint is used, our staff must be able to justify their actions from a professional and legal standpoint. We report all incidents of restraint to make sure we have an accurate picture which we can learn from and improve our practice.

“We are continuously exploring and monitoring the latest research and evidence and adapt our training and policies if we believe there are more effective methods available. We work in partnership with colleagues nationally to ensure that best practice is being widely shared.”