To think that face down restraint is never acceptable

[ReallyTired]

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.

[hellhasnofurylikeahungrywoman]

Gold I have worked in a special school and have been trained in de-escalation and positive handling but the county I work would never, ever sanction a child being educated while they were being restrained. All restraints were used for the shortest possible time. It is absolutely wrong to use restraint in that way within a school.

[MammaTJ]

Another AIBU where the OP refuses to read the replies that say YABU!

Read what MichelleRouxJnr has to say OP before replying again I have no problems with physical intervention done in the right circumstances. I have issue with face down restraint. which you said after they had posted. I think that they have given a perfect example of when it is not only acceptable, but absolutely necessary.

[Doubtfuldaphne]

I just wants to share my story.. I was 10 when I developed school phobia. I became terrified and physically ill if I had to go to school after suffering a panic attack during a class and no one knew what was wrong with me. (This was in the early 80s)
A social worker was brought in to just get me to school.
Every morning I was restrained face down. I was really scared. Only now I realise what an absolute bitch this social worker was and it made my problem ten times worse.
That's the only experience I have of face down restraint.

[HollyBerryBush]

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

Ian Brady has been arguing that corner for 13 years.

[plentyofsoap]

Put yourself in very violent and dangerous situations before making such judgements really.

[Madamecastafiore]

I have seen it used on an 16 year old drug induced psychotic patient after de escalation had failed by 3 senior clinicians. He was in the process of attacking a nurse, had her cornered after picking up a huge flat screen telly (not one with a flat back but the big old huge ones) and throwing it around as if it was nothing.

Face down restraint is used as a last resort, the people who do it are trained to use lots of techniques first.

Seriously I only see mentally ill adolescents but sometimes that illness can give you the strength of 10 elephants and as you can't fight back when being attacked but just restrain for the patients and your safety face down restraint is often required and the best thing for safety of the patient and staff.

Can I ask if you just saw the report on TV or actually have any experience of being in a mental health or criminal setting?

[Madamecastafiore]

Oh and you have to use the mental Heath act to force feed someone (although this means the insertion of an NG tube and not holding someone down and forcing food into their mouth!) it is done as a last resort.

[rainbowslollipops]

I always thought restraint was when you stop a dangerous person from becoming a danger to others in a bad & angry situation. I thought force feeding someone wasn't restraint but welfare of their health.

[Doyouthinktheysaurus]

I have just done my prevention and management of violence update and there has been a huge shift towards supine restraint.

Whereas we used to be taught prone first and foremost, with supine as an alternative based on clinical need, we are now advised to use supine techniques with prone as a last resort, and turning once the patient is on the floor if the patient is prone.

Turn from supine to prone to medicate and straight back.

According to our trainer, prone restraint is now banned in psychiatric units in Wales.

[Madamecastafiore]

And if staffing numbers were high enough a lot of incidences of where restraint is needed would not happen.

A funding issue again!

[MammaTJ]

Madame, that was the case even as far back as the 80's wrt force feeding.

[delboysfileofax]

What a crock of shit OP. how many people have you restrained? The people/trainers who come up with the restraint system clearly have no idea how it works in reality. It's often taught with lots of staff being available for each limb and the detainee starting at a compliant point. ie already in whatever position is needed for that particular restraint. It's bollocks and it never ever works in reality

[Madamecastafiore]

But I think for people who do not know anything about management of people refusing to eat the phrase force feeding is inflammatory and gives a different impression of what it is.

[CloudsAndTrees]

This isn't something I know much about, I have no experience and the article linked to in the OP gives little information.

From the POV of a layperson, I think other methods of restraint should be used if possible, but I also think that the priority is to protect staff, other patients, and the patient themselves. If staff are in a situation where they are using face down restraint for a reason, then I don't think it's fair to talk of punishing staff. They put themselves in dangerous situations for the good of other people, and their protection is more important than dignity IMO.

[attheendoftheday]

The BBC article identifies a lot of restraint being used, not unnecessary restraint being used. Perhaps the story should be that large numbers of nurses other staff and other patients are subject to violence of a level requiring restraint on a regular basis.

I've seen some pretty horrific attacks while I've been a mh nurse, including a colleague being stabbed multiple times, nearly resulting in their death. Face down restraint is the safest option in a really scary situation - the mechanics of the body mean it's harder to fight.

[Bobyan]

What atthe said.

And as for "Done with as much love possible" you clearly haven't been scared for your life by a violent patient have you OP?

[ScarletLady02]

I have a friend who works in a psychiatric unit where the patients are very violent. I'm not sure of the correct terms, sorry, but the patients need to have 5 or 6 people with them at all times if they are moved or anything like that (I'm probably explaining it wrong, sorry if I've offended anyone). He is trained in face down restraint and it is only ever used as a last resort. When you have a 20 stone violent patient who doesn't have the mental capacity to be reasoned with and they are biting and tearing at you, I don't see what other choice people have. It can't be a lot of fun for the people doing the restraining either I wouldn't have thought.

If any form of restraint is used inappropriately then of course it should be dealt with, but I'm sure it isn't just used for the hell of it.

[Doyouthinktheysaurus]

I agree with the switch of emphasis from prone to supine. It is safer for the patient, postural asphyxiation is not a myth, it is a reality. Also I think the patient being face up can benefit verbal de-escalation. If the patient was being so aggressive supine was risking staff injury, I would push for secluding them, not remaining in prone for any period.

Restraint should only ever have a core team of 3 anyway. One on each arm, one on the head. A person on the legs, only if needed. In the prone position with someone on the legs, the pressure on the chest is massively increased. Obviously the more pmva trained staff available the better, but only for wider management and swapping team members.

[yaimee]

I think this thread shows a fairly shocking lack of consistency amongst those who work in settings where restraint is used.
There should be standardised training, shouldn't there?
It certainly seems that at the moment the training is open to interpretation by both the trainers and those being trained and that not everyone is using the same methods of restraint or using restraint correctly.

[Goal]

I would guess that it because those posting work in different types of settings

[yaimee]

That shouldn't mean they have different attitudes to use of restraint.

[Doyouthinktheysaurus]

I agree with yaimee, there should be more consistency.

The trainers who train us wrokign in acute care also train those working in forensic and secure services, with exactly the same techniques!

[shewhowines]

As someone who is completely ignorant on this, I would view it this way.

1. The safety of the carer always comes first, and trumps the welfare of the person needing restraining.
   
2. The least invasive restraint technique should be employed.
   

The trouble is, there is a very large grey area, when someone is feeling threatened and in danger.

I would defend the right of the carer to go in too hard, rather than put themselves in danger by worrying about consequences. Obviously if there is a pattern of always being far too heavy handed, then these people are not suited to the job and/or need greater training.

[sweetestcup]

So you have never worked in acute psychiatric inpatient setting OP and faced the situations I used to... and yet you think you can judge about the use of restraint there and waffle on about love?!! You really don't have a clue....