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.

[MammaTJ]

*1. The safety of the carer always comes first, and trumps the welfare of the person needing restraining.

1. The least invasive restraint technique should be employed.*
   

Yes, that. The thing is, what the OP is talking about often is the least invasive technique possible. My experience of working in a psychiatric hospital really is a long time ago, but that was the case even then.

[bluestar2]

Yabvu. Clearly you have never been in position where you have had to deal with violent people.

Yaimee every situation is different and requires a different response based on environmental and physical aspects. Every response should be tailored to achieving what needs to be achieved using as little force as possible. There can he no one set of rules to follow in a stringent order but rather a box of techniques or tools which the trained personnel can pick from the appropriate one.

[mignonette]

Sometimes restraint techniques have to be used after an unexpected outburst that places all those in the vicinity at risk.

But in my experience as a RMN on various PICUs, FIPMHU's over the last 20 years, restraint is used because staff have failed to act upon earlier and obvious signs of a deterioration in mood and escalation of risk. The risk assessment process is only useful if staff maintain awareness of the 'mood temperature' of a unit and take pro active action.

There are many reasons why this may happen- low staff levels, poor skills, poor management and ward/unit culture. But having to use restraint should be seen as a 'failure' of sorts and actions taken to identify why it happened and whether an earlier intervention would have prevented it.

[giantpurplepeopleeater]

ReallyTired - I don't think you can judge until you work in these roles. As some one up thread said, sometimes it can be an 'out of the blue' attack, can put others in danger and actually the only suitable response.

Having a brother who is a policeman, a friend who is a prison officer, and another friend a nurse on an MH ward, all of whom come across people with MH issues every day, and equally violence every day, I would most certainly not (a) presume to think I know what it's like, or know better (b) ask them to put their safety over and above the dignity of the individual involved.

I can only imagine the sheer second you would have in these situations to decide what to to do. And if face down restraint would remove most of the risk before any serious violence was done, then I can only support that.

[ReallyTired]

I had physical intervention training in my last job. It is perfectly possible for to physically restrain a large and strong adult without putting them face down.

When a restraint goes wrong it can result in death or injury of the patient.
This mind article shows that trust vary a lot on restraint methods used.

www.mirror.co.uk/lifestyle/health/mental-health-charity-mind-call-1962542

I find it shocking that half of face down restraints happened in two NHS trusts. Face down restraint is more dangerous than other methods of restraint.

I think that people on this board forget that pychiartic impatients are not criminals and they are often very ill. It does not need a mental health qualification to say that these people deserve to be cared for. Certainly there are times when restraint is needed but still important to avoid pain and lack of dignity.

"I can only imagine the sheer second you would have in these situations to decide what to to do. And if face down restraint would remove most of the risk before any serious violence was done, then I can only support that."

That is where proper physical intervention training comes in. Lots of organisations can restrain adults in safe ways that does not involve face down restraint.

[Alisvolatpropiis]

Oh and FYI you can't force somebody to eat it's against their human rights


Erm...yes you can.

[Idrinksquash]

Ok. So you "can" forcefeed people. Just not in my trust, or the private inpatient unit I used to work in.

now lets all get back to the OP's point instead of repetitive posts correcting me. I made a mistake, it only needed correcting once. Vipers, the lot of ya

[Alisvolatpropiis]

Sorry Idrink

Re op's point - I don't think any professional who works in a field in which physical restraint can be a part should do anything out of "love". Nor out of hate. Way too strong an emotion.

They do it because they are professionals and it is their job to keep that person and others safe from harm. As others who have worked in physiatrist ward said, sometimes prone restraint is the only way.

[Alisvolatpropiis]

*physchiatric even

[Alisvolatpropiis]

Ohh FFS!

[BinksToEnlightenment]

I've seen it used frequently and inappropriately, and experienced it personally. It's not a nice thing and denying that there is any chance a culture of inappropriate restraint could develop is not helpful. The place I have seen it used would never have been closed down if no one had considered the possibility it was happening.

[Jollyb]

Really tired - you've had the training but have you ever had to use it in real life?

[Tomorrowslookingfine]

I too question how often OP has had to use restraint?

[Onesleeptillwembley]

Ok, OP, you have an extremely large, strong and violent person who is HIV positive attacking someone. You have to stop it. The attacker has previously bitten off part of a colleagues' face. Has tried to bit on many previous occasions. Also bites own lip and spits. What exactly do you do, within strict legal constraints?
I think you need to grow up and realise that you shouldn't really be making such ridiculous black and white judgements about which you admit you have no experience. Or do you just want to make some jobs so dangerous nobody would do them?

[Blissx]

Just wanted to say how amazing some of you are to do the jobs that you do. Just hijacking the thread to say how much I admire those on this thread who work in the environments described.

[PenelopePipPop]

I want to say how much I admire Fluffydressingdown who has experienced restraint herself as an inpatient and come on to this thread to say that it was necessary, that it was acutely distressing and undignified and that staff need to be aware of both the short and long-term effects of using restraint when they assess how to intervene in a situation. In other words that she does not blame the people who intervened in her care in the way they did but it would be good if we thought more deeply about the patient's experience of restraint, not just as dangerous or frightening but also as triggering flashbacks and making them mistrustful of services in the long-term.

You are awesome Fluffy.

[fluffydressinggown]

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.

[YoniRanger]

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.

[PenelopePipPop]

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.

[mignonette]

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)

[fluffydressinggown]

Penelope I just read your kind words about me, thanks :)

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

[CloudsAndTrees]

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.

[Spikeytree]

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?

[mignonette]

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 ) 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.

[Doyouthinktheysaurus]

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.