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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

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.

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.

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.”

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

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.

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.

attheendoftheday Fri 21-Jun-13 17:46:26

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.

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

Love? confused

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


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.

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.

Madamecastafiore Sat 22-Jun-13 16:13:33

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

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.)

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.

fluffydressinggown Sat 22-Jun-13 23:14:27

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

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.

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

Going back to the clip on the BBC website

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.

Madamecastafiore Sat 22-Jun-13 23:54:14

I am fully aware what psychotic means thank you.

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.

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