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.

MillieN Mon 24-Jun-13 18:05:59

Sadly, restraint is needed occasionally. But to say that at times it needs to be face down is just not true. I live in an area where Mental Health Services have a very different approach. I used to work in the service myself and know from experience that the process we now call RESPECT which underlies all our treatments on the ward and in the community has changed the service we have tremendously. Nurses have commented that they can now be"nurses and not jailors " Patients are not scared to go to hospital and can even learn about the process for themselves. Service users participate in staff training and injuries have been greatly reduced. Google Respect and NAVIGO to find out more about how this worn and how it came about. Those who tell you there is no alternative have not done their homework. Respect is not the only solution on offer, but it is an excellent system that works. You really should check it out.

I am fully aware what psychotic means thank you.

ReallyTired Sat 22-Jun-13 23:53:49

Going back to the clip on the BBC website

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

Naomi Ball was a child when she was restrained face down. (aged 17 years old.) Restraining a 17 year old child face down in the special school I used to work in would be gross misconduct. Why is it OK to restrain a pychotic child in a face down position, but not OK to restrain an autistic school child of the same age?

The hospitals that thetrackisback and Kasterborous have reasonable restraint policies. There is a difference between a patient ending up in a face down positon and being turned over as quickly as possible and diliberately putting someone in a face down position. Restraint is sometimes necessary, but it needs to be safely done.

fluffydressinggown I think that you are very brave to read this thread as some of the attitudes on this thread are not much better than biblical times when people thought that pychotic people were pocessed by demons.

I hope you are well and this thread is not upsetting you too much.

Kasterborous Sat 22-Jun-13 23:39:31

I worked in a hospital for patients with mental health issues and very challenging behaviours. We had control and restating training and yes we were taught not to restrain anyone face down. But equally we were allowed to use reasonable force if it was for their or our own safety. On the odd occasion face down restraint occurred we turned them over when possible. We did have a couple of quite obese patients and they could never be restrained face down in any circumstances. If someone is throwing furniture at you or going for your throat you have to act.

Psychotic does not mean violent. I am horrifed at some of the comments on here.

thetrackisback Sat 22-Jun-13 21:53:48

Face down restraint has been banned in some mental health trusts and we are trained never to do it. Obviously if you are in a situation of danger the person may end face down but there are techniques to turn the person over of needed. What is worrying is the disparity between health trusts. Some health trusts do use restraint to soon and not as a last resort and this is illegal as it would be classed as unreasonable force.

ReallyTired Sat 22-Jun-13 20:29:36

"I thinks thats very condescending to anyone working in a hospital like a RMN for example."

I am sorry that you find that comment condescending; however some posters on this thread certainly need reminding that vunerable people are human.

Certain posters don't seem to care if someone suffers cracked ribs or a caridac arrest. The risk of a fellow person suffering spinal injuries is deemed OK because they are pychotic and possibly dangerous. Many patients experience post traumatic stress from a brutal restraint.

"Staff are very vulnerable when being faced with a psychotic patient willing to rip their heads off too!!"

Staff get to choose their careers, patients don't choose to be ill. Risks are far less with proper training and reasonable patient to staff ratios.
Staff can leave the ward where as the patients don't have that kind of freedom.

It would be interesting to know what proportion of people who are restrained face down are actually violent to someone else. (Rather than trying to escape, self harm, damage property or refusing to take medication.)

Staff are very vulnerable when being faced with a psychotic patient willing to rip their heads off too!!

sweetestcup Sat 22-Jun-13 16:11:04

People in hospital or a care home are very vunerable. Even if they are self harming, criminals, have HIV, on drugs they are still human

I thinks thats very condescending to anyone working in a hospital like a RMN for example.

ReallyTired Fri 21-Jun-13 22:11:50

"Love?"

Love as in the broadest sense ie. What christians mean by "love your neighbour as yourself". ie. treating those around you as you would like to be treated yourself. Admitally very few people these days are christians, but plenty of non christian people share similar senitments.

I have never had experience of restraining someone in a prone position and I have only never had experience of a sitting position or a walking restraint. Physical restraint is both physically and emotionally tiring. Certainly a sitting restraint requires a lot of stamina because you don't have gravity to help you (and often the restrainee has more stamina than the staff.)

Prolonged physical restraint in a prone position is incredibly dangerous because there is more weight on the patient. I feel that risk of killing/ hurting the patient outweighs the benefits of being less tiring for the staff. I imagine that killing the patient is a pretty swift way to finish a career.

However with a sitting restraint communication is easier and its quicker to calm the person down. Even if it requires more stamina for a sitting restraint it usually is over faster because you can make eye contact with the restrainee.

valiumredhead Fri 21-Jun-13 18:53:58

Love? confused

While I would always think that the least restrictive form of restraint should be used, I really believe that face down restraint is sometimes necessary. I've worked for many years on a forensic ward, with patients mostly transferred from high security prisons. It is simply much harder to restrain someone sitting up or face up.

I'm sorry that people have seen restraint being used inappropriately, that is clearly not acceptable and I'd encourage you to complain. However, my experience is that no one likes restraint and it is only used when really necessary i.e. when there is an ongoing attack, or to prevent dangerous prisoners from escaping or life threatening self-harm. If a patient throws a single punch and leaves they would not be restrained.

ReallyTired Fri 21-Jun-13 17:19:00

"It is obvious that prone restraint is not the preferable course of action and should be avoided but sometimes it CAN'T be avoided."

I agree that restraint can't be avoided, however lying someone face down can be avoided. There are restraint methods that are less traumatic, ie. restraining someone in a sitting position. Training may well be required to show staff better positions for restraint.

"Having witnessed my 5ft and barely 7 stone sister being 'restrained' for the crime of trying to open a door on a locked ward I have to say that I think restraint is used inappropriately at times."

What Spikeytree's sister experienced was assault. There is no justification for sticking a knee in someone's back. It was an abuse of power and the members of staff should have been disciplined. Sadly people with pychiatric problems or learning difficulties are very vunerable and are easily bullied.

People in hospital or a care home are very vunerable. Even if they are self harming, criminals, have HIV, on drugs they are still human.

Special schools in my county do not use prone restraint and they educate children up the age of 19. Infact there are NHS authorites who have a policy of not using prone restraint already. When restraint is necessary they use methods that do not cause pain to the patient/ student.

Where I used to work all physical intervention was logged and parents were told if their child had been restrained and why. There was a very clear audit trail.

mrsdrew Fri 21-Jun-13 15:15:13

I haven't worked on acute units for a few years but visit them regularly as part of my job. I hated using C and R and it was always used as a last resort. It is obvious that prone restraint is not the preferable course of action and should be avoided but sometimes it CAN'T be avoided. I could share many 'horror stories' as others have about sudden attacks or acts of self-harm. I don't think any of the posters say prone restraint is fine or should be used as a matter of course but sometimes it HAS to be used even for a short period. And depending in which environment you are working in, some of the service users ARE criminals and thankfully, NHS trusts are now pursuing more assault charges as it is now realised that being in hospital does not mean you can go around sexually or physically assaulting staff and other service users with impunity. And in my experience, staff do not wish to press charges against people that did not know what they were doing or could not be held responsible for their actions.

KatoPotato Fri 21-Jun-13 14:43:45
KatoPotato Fri 21-Jun-13 14:41:47

Taken from the 2003-2004 - House of Lords and House of Commons Joint Committee on Human Rights Death in Custody Report - Restraint in the Prone Position

“246. Restraint in the prone position has been particularly controversial because of the dangers it carries to the patient, and it has been implicated in a number of deaths.”

“248. Reliance on prone restraint is a matter of concern for compliance with Article 2, given the known dangers of this position, evidenced by previous deaths.”

“248. ……we emphasise that Article 2 requires that patients and detainees should not be placed at risk by use of this position unless absolutely necessary to avert a greater risk to themselves or others, and that they should be restrained in this position for the shortest possible time necessary. In our view use of the prone position, and in particular prolonged use, needs to be very closely justified against the circumstances of the case, and this should be reflected in guidance. Equally importantly, those restraining a detainee should be capable of minimising the risks to him or her, through techniques to ensure, amongst other things, that airways are not blocked. They should be appropriately trained to do so.”

Doyouthinktheysaurus Fri 21-Jun-13 14:35:12

I am pleased to see a few more posts sharing my view about prone restraint.

Tbh I find it a bit disturbing that people are dismissed as not being able to have an opinion because they have never had to restrain anyone or deal with a violent patient.

I think it's vital that acute services really are utterly transparent and open about what goes on. Patient welfare has to be our primary concern at all times, that doesn't change because they are trying to assault staff! Yes we have to intervene but the patients welfare remains paramount.

If physical intention is needed, 'the least restrictive intervention' is the concept we should all be following.

I don't honestly believe there is much, if any justification for the continued use of prone restraint in acute mental health and I hope things do change for our patients sake.

mignonette Thu 20-Jun-13 22:36:30

Fluffy

It is vital that we really hear you as a service user. The moving way in which you articulate what must have been an awful ordeal in the main makes you truly inspirational in my eyes.

And yes, not just paying lip service to a post incident de-brief ( sorry for the jargon-speak. I am institutionalised into it smile) but really using it to honestly explore why a situation deteriorated to the point of requiring such interventions, is fundamental to the development of more effective less aggressive management of hostile and aggressive behaviour. And restraint can never feel anything less than an aggressive imposition not only to the patient undergoing it but to all those who witness it.
i have, on too many occasions, had to reassure and calm other patients, visitors and passers by who have witnessed a full blown C+R incident. It is very very disturbing to witness and unfortunately staff can become inured to this aspect of it too. They focus upon their de-brief and forget the ward full of patients outside the office door.

Spikeytree Thu 20-Jun-13 22:34:58

Having witnessed my 5ft and barely 7 stone sister being 'restrained' for the crime of trying to open a door on a locked ward I have to say that I think restraint is used inappropriately at times. There was no way she could have got the door open, she was only trying to leave a situation where the nurse had wound her up by telling her that if her children were left with an inappropriate carer by her husband it was her own fault for being in hospital. At one point someone was kneeling on her back. I worry that if they can do that in front of her family, what were they doing when there were no witnesses there?

CloudsAndTrees Thu 20-Jun-13 22:30:47

Again, I have no personal experience, but it sounds like a prone restraint could be avoided if only there were the resources available to make it happen. And that would take a huge increase on staffing and provision right from the start, and more importantly, would cost a seriously huge amount of money.

It's not going to happen. And the amazing people that put themselves in the position of ever needing to restrain someone have to do what they can with the resources available to them.

Penelope I just read your kind words about me, thanks smile

Migonette - it is nice to see someone working in front line MH questioning things, I think this is the key, not just about banning prone restraint but questioning the events leading up to it and then exploring what happened afterwards so it can be prevented

mignonette Thu 20-Jun-13 21:56:20

I was not defensive Penelope. I am an RMN and my earlier post made a point very similar to yours- that most restraint can be avoided; that it should be a last resort; that de escalatiom techniques are often very poor or the will to use them is not there and that there are a myriad of reasons as to why a culture of using restraint develops within a trust/workplace.

I now work as a senior CPN in crisis management because I was no longer prepared to work in in patient services in my trust, one which uses restraint far too freely and recklessly in my view. And I am a thorn in the side of senior managers in my attempts to question every incidence of it being used if and when any of the clients on my case load have to be admitted.

(I have worked in a very well known Forensic hospital giving me ample experience of prone and supine C+R and calling it 'care and responsibility' instead of 'control and restrain' doesn't make it any more pleasant to perform or be on the receiving end of)

PenelopePipPop Thu 20-Jun-13 20:34:53

Yep and there is a huge body of empirical evidence that would support you. Depending on the type of setting a combination of improved staff training, the use of de-escalation techniques specific to calming agitated patients in emergency care, and changes in policy and leadership can all dramatically reduce the use of seclusion and restraint. Happy to provide cites for all that - this is my academic specialism and yes I have worked with loads of people suffering severe psychotic breakdowns.

There are Mental Health Trusts in England and Wales which have shown this kind of commitment to improving the safety of their staff and patients, and there are others which have not. That is the point of the news story which ReallyTired linked to.

I can understand why people who have carried out facedown restraint probably feel a bit shit about it. To be told it might not even have been a justified practice, and that alternative techniques might have been safer and better for everyone involved (and that in the neighbouring county that might be what happened) is a kick in the teeth. That might be why you got such a hostile reaction on this thread. It is still a bit sad to see mental health professionals responding so defensively and patronisingly when a service user takes the time to articulate why restraint is unpleasant and how it can be avoided.

YoniRanger Thu 20-Jun-13 20:24:34

Restraint of any kind should be the absolute last resort. Prone restraint should be avoided because its vile for the person, dangerous and in a situation where medication is not involved it is really unlikely to calm the situation.

That said if the alternative is more likely to cause significant harm then you do what needs to be done.

ReallyTired - thank you for your posts on this thread, I feel very sad reading some of these comments tbh.

Actually I consider my dignity, my welfare, my safety to be as important as those looking after me. When I was unwell I was incredibly vulnerable, I was so unwell that I was, at times, not safe enough to be alone to pee. I could not leave the building, I simply did not have the capacity to make my decisions. At that time I needed people to make the safest decisions for me and some of them did include restraint. But I am not a criminal, I did nothing illegal, I hurt noone other than myself. I mattered just as much as those staff.

I feel like if you read this you will read that those in psychiatric units are violent and angry and aggressive. Mostly people are exhausted and scared. And I would agree with the poster that said that in many cases restraint is the end of an series of behaviours that could be prevented. Many times when I was restrained I had clearly indicated I would not be able to keep myself safe, sometimes they changed my obs or offered support, but at times I was literally left to hang myself. I think personal responsibility is important but it is and was very frustrating to have people stopping me from doing something that I said I would do.

Having your choices, your control taken away from you is horrendous. Can you imagine having the choice of taking medication 'voluntarily' that you don't think you need or want and that has very significant long term side effects or being pinned down and injected with it. These were decisions I faced weekly - at a time when I found even deciding what to watch on TV to be hard. Psychologically it is very very difficult to manage.

Restraint is needed to keep people safe but like I say it needs to be remembered how much an impact it has in the longer term.

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