To think that face down restraint is never acceptable

(92 Posts)
ReallyTired Wed 19-Jun-13 23:08:23

I was shocked to see this on the BBC website

www.bbc.co.uk/news/health-22959312

Certainly restraint is sometimes necessary in mental hospitals or schools, but it needs to be done with as much love as possible. Restraint should be reserved for situations where the alternative is far worse. (Ie. force feeding an anorexic child close to death who is far to ill to make a decision about eating can be a loving act.)

There are lots of ways of doing restraint that are far safer than face down and preserve the dignity of the person. Restraint should never be done for sheer convience. When restraint is done inappriopiately then the staff should be punished.

Idrinksquash Wed 19-Jun-13 23:16:34

Face down restraint isn't used willy nilly you know.

As an RMN I can assure you there are a lot more appropriate uses for restraint than forcefeeding a person suffering with anorexia nervosa. I was once shoved into a wall and punched in the stomach by a service user at 28 weeks pregnant. C

Idrinksquash Wed 19-Jun-13 23:19:31

Oops.

It was completely out of the blue. No warning signs, no 'situation' I could have dissolved. Really pisses me off when people jump on the "nurses are horrible to patients" bandwagon.

complexnumber Wed 19-Jun-13 23:20:50

"Certainly restraint is sometimes necessary in mental hospitals or schools, but it needs to be done with as much love as possible."

I don't thing 'love' needs to come into it.

When one person becomes a danger to him/herself, yourself and to others in your care, you need to respond accordingly if it is your job to supervise.

Idrinksquash Wed 19-Jun-13 23:21:00

Oh and FYI, you can't force someone to eat. Thats against their human rights.

Dahlen Wed 19-Jun-13 23:21:49

Hmm. On the face of it of course YANBU. But that's the trouble. Things are rarely as they seem on the face of it.

Public servants on the front line are just people. Like you and me. They can be trained in techniques and assessed for suitability in temperament, but when it all goes wrong and it becomes a physical battle of wills, they have a right to protect themselves and end the physical conflict as quickly as possible with as little physical damage as possible. Sometimes that it is going to mean face-down restraint because there is no time or opportunity to work out how to do it any other way. That doesn't mean they shouldn't be held accountable for extreme use of force of course.

complexnumber Wed 19-Jun-13 23:28:04

I'd be interested to learn of the "lots of ways of doing restraint " when you are being threatened with a kitchen knife.

YouTheCat Wed 19-Jun-13 23:31:00

You do realise that that kind of restraint will be a last resort and will only be done by those qualified to do it, OP?

KatoPotato Wed 19-Jun-13 23:31:31

I'm an MVA trainer for secure sites, as a policy we never train face down restraints or to prone. We teach staff to be aware of legalities and their own rights and of the rules of proportionate and reasonable force.

ReallyTired Wed 19-Jun-13 23:34:51

What situation requires face down restraint? There are far safer and more humane ways of restraint. Surely the aim of physical intervention is not to terrify or to inflict pain. Carers should look to maintain a safe enviroment.

I have no experience of mental hospitals. I have seen physical restraint in a special school situation. I have seen large teenage boys being restrained without being face down. In fact I had training on how to do physical intervention. It is important to choose restaint techniques that maintain dignity and are as safe as possilbe.

KatoPotato Wed 19-Jun-13 23:35:16

If you are being threatened with a weapon then your first response would be to make your escape and try and isolate them. If you were unable to do so then the rules of proportionity and reasonable force would be applicable.

I'm an MVA and restraint trainer and we never teach any prone or face down techniques as the consequences are horrific.

KatoPotato Wed 19-Jun-13 23:35:53

Sorry, thought first post had vanished!

sweetestcup Wed 19-Jun-13 23:36:23

I presume by the term "mental hospitals" you mean acute psychiatric in-patients wards OP? Have you ever worked in one and faced a patient requiring restraint? I am an RMN and I have and I can assure you it was always based on a clinical judgement that it was the only option, such as to maintain their safety, the safety of fellow patients or staff.

I have been restrained in a mental hospital (not face down).

It is traumatic being restrained, very unpleasant and upsetting. I think in some ways it made being IP more stressful, I was very scared of it happening again (and it did).

However, it was done to protect me from killing myself, it was to protect me. I think it was used appropriately.

I have never seen restraint used lightly. I think it must be hard work being a MH nurse. I certainly think that part of training needs to include the patient experience, I would have liked a debrief afterwards.

It is hard to explain how it feels to be restrained, to be held down like a criminal when you are not one.

KatoPotato Wed 19-Jun-13 23:55:22

You're absolutely right fluffy and when a site finds that the need for restraint is high then there are a number of newer alternatives like restraint belts and the like which are highly effective.

MichelleRouxJnr Thu 20-Jun-13 00:07:09

Hello OP
Today I had a coffee table thrown in my direction by a man who was approx 6'3 and 20stone. Not fat - muscley.
I'm 5'6.
As he spat and swore and tried to prise the bookshelf from the wall I was most pleased when 5 health care workers arrived (after I pulled my alarm) to control and restrain him - prone - and reassure him he was safe and talk kindly to him while I drew up and administered some medication.
The medication was administered to his buttock area, which would have been inaccessible had he been supine.
When I left the secure mental health unit I work in, he was sleeping and the other 12 patients and the staff were safe.
In a few weeks he will be mortified by his behaviour and thank us all for keeping him safe.
As he has been the last 3 times he has had a distressing violent psychotic episode.
'Love' ???? Get real - we are professionals who treat people with respect and try to uphold their dignity while keeping ourselves and others safe.

Goldmandra Thu 20-Jun-13 00:09:49

I don't know about restraint used in psychiatric wards but I am concerned about how restraint is used in schools.

I have two DDs with AS who attend Autism-specific provision. My own DDs have never been restrained in school, although there is a chance that DD2 may need this at some point to prevent her from running into danger.

I am aware though that restraint is used in that provision for reasons I don't feel are justified. They use physical restraint to force pupils to attend lessons when they don't want to go and as a just-in-case measure when a child appears upset.

I have seen one child being taught while being restrained. I can't imagine what they thought he might be learning.

When I have raised concerns I have learned that restraint for these reasons is considered acceptable in schools.

I've written to tell them that restraint must never be used on my DDs unless they are putting themselves or someone else in danger.

I have also been told that there is no legal requirement on the staff to inform parents when restraint has been used.

YouTheCat Thu 20-Jun-13 00:12:16

Gold, tbh that doesn't sound right at all.

I would not expect a face down restraint to be used in a school setting.

ReallyTired Thu 20-Jun-13 00:12:58

Surely restraint belts are similar to the straight jackets used in victorian times. It would require force to get someone in a straight jacket.

I have never worked on an acute psychiatric in-patients ward. I have worked in a special school where large teens have been restrained for their own protection or other people's protection. I even had training and we told that putting someone in a prone position is dangerous.

The school I worked in tended to restrain children is a sitting postion. Much of physical intervention training is descalating a situation. If someone is face down then it makes communication with them hard. Surely face down restraint makes it harder to descalate a situation. How can you talk to someone if their face is in the carpet?

I have no problems with physical intervention done in the right circumstances. I have issue with face down restraint. Some health trusts have already banbed face down restraint and I feel the rest of the country should follow.

MichelleRouxJnr Thu 20-Jun-13 00:18:17

What's a restraint belt?
Restraint is safely handling a person to a position where they cannot hurt themselves or others and holding them there for the shortest time possible?
I appreciate the difference in children/adolescents and adults but as a forensic practitioner in a secure hospital I can assure you that sometimes a short (minutes) time in a prone restrained position is the only safe option.
Perhaps you ought to amend your title and OP to show you are talking about children.

KatoPotato Thu 20-Jun-13 00:20:33

michelle I teach restraint positions that do allow you to administer medication in the buttocks without the risk of death by prone and corporate manslaughter litigation. If you want deatils for you site please pm me.

Michelle - I appreciate how difficult your work must be, I have not been an IP in a forensic unit although I have been IP in PICU and seen restraint used there.

But, not everyone who is restrained is being violent towards staff or other patients. I am peaceful, but I was not going to let anyone get near my neck to cut off a ligature and I really didn't want to go into seclusion because what I really wanted was to leave the unit and kill myself. And restraint was used to keep me safe from myself.

I guess I am coming from another perspective and I think it needs to be 50/50 when looking at the impact of its use - on staff and on patients.

I am mortified that I had to be restrained, I was psychotic and not thinking straight, it was the right thing to do. I was made aware that I would be restrained to be given medication if I did not comply. The whole thing is frightening and scary - just as much for patients as for staff.

I am scared of being re-admitted to hospital and I think it is unlikely I would ever go in informally because I would be scared of being sectioned while IP and restrained to take medication, and scared of being restrained to stop me doing things. Hard to explain.

The day after I was first restrained I had a very very vivid flashback dream about being raped, the first I had had in years. Very difficult and upsetting and led to a really bad few weeks for me. Restraint has a huge impact and it is important for all staff to remember that.

If face down restraint can be banned in some trusts it can surely be banned everywhere?

IneedAsockamnesty Thu 20-Jun-13 00:59:44

Gold,that is not correct. If the situation is as you describe then its a misuse of positive handling.

It would be worth bringing it to the attention of ofstead and the LA

martha2013 Thu 20-Jun-13 03:54:17

I have been restrained, face down, as an inpatient a couple of times. I am horrified to think of this now, not because of the discomfort or humiliation but because of how appalling my behaviour is when I'm unwell. I'm glad the nurses had an established method of dealing with the situation that kept everyone safe. I would certainly agree, however unpleasant, that it has its place.

McGeeDiNozzo Thu 20-Jun-13 05:14:13

'Oh and FYI, you can't force someone to eat. Thats against their human rights.'

Not necessarily. Sometimes it is and sometimes it isn't.

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