MIND RESTRAINT REPORT
INITIAL RESPONSE
‘Mental Health Care Crisis Care: Physical
Restraint in Crisis. A report on Physical
Restraint in Mental Health Settings in England’
Background
• On the 19th June 2013 MIND published a report ‘Mental
health crisis care: physical restraint in crisis. A report on
physical restraint in hospital settings in England’.
• The report focused on the use of physical restraint in
mental health settings in England and attracted
significant local and national media attention, particularly
in relation to the use of the prone restraint position (face
down).
• The data contained within the report was gathered by a
Freedom of Information (FOI) request in February 2013
to all 54 Mental Health Trusts in England. The FOI
request asked for a response to nine questions:
Nine Questions Asked in the FOI Request
1. Total number of incidents of physical restraint by one or more members of
staff
2. Total number of patients who experienced physical restraint by one or more
members of staff
3. Total number of incidents of face down physical restraint by one or more
members of staff
4. Total number of incidents where physical restraint was used to administer
medication
5. Total number of incidents where police were involved in physically
restraining a patient
6. Total number of incidents of physical injury following physical restraint
7. Total number of incidents of psychological harm following physical restraint
8. Total number of incidents of physical restraint resulting in death
9. Total number of complaints received following physical restraint
Highlights
It is important to note that there was significant variation in terms of the
number of Trust responses and the data completeness of those
responses. This makes it extremely difficult to draw any solid
conclusions from the data.
• 47 (87%) of trust’s provided information on the total number of
incidents of restraint.
• Only 27 (50%) trust’s provided information on the number of prone
restraints (NTW reported the highest number 923).
• Only 31 (57%) gave information on restraint and medication.
• Only 27 (50%) gave information on police called / involved.
• Only 34 (62%) gave information on injuries.
• 14 (25%) gave information on psychological harm.
• No deaths – 36 injuries all of which were minor.
• We know at least two of the four trusts highlighted as not using face
down still do.
Rationale
•
•
•
•
•
We are one of the largest mental health and disability trusts in the country,
covering two large cities in the North East, as well as providing both
regional and national specialist services.
However our figures are comparable to other mental health trusts of similar
size and who also provide a similar range of regional and national specialist
services.
Due to the specialist nature of a number of our services such as our
forensic services, the trust cares for some of the most complex and
challenging patients from all over the country, which means that the figures
may be higher when comparing us to other trusts without such specialist
services.
Analysis of our figures has shown that a small group of less than 50
patients, who demonstrate very complex and high risk behaviours account
for over two thirds of all the recorded incidents of restraint.
The Trust is an open and transparent organisation with a strong culture of
reporting all episodes of restraint, regardless of type.
Data Return
Incidents of
physical
restraint
Patients
experiencing
physical
restraint
Incidents of
face down
restraint
Incidents of physical
restraint resulting in
physical injury
Complaints
relating to
physical
restraint
Declared
total staff
Population
TEWV
3346
398
Not provided
1
0
5839
1,400,000
Lancashire
3018
851
Not provided
200
7
8130
872,400
Southern
Health
3003
3133
810
Not provided
0
7691
770,200
NTW
2660
384
923
36
2
6709
1,400,000
Birmingham
& Solihull
2043
251
Not provided
14
4
4480
765,200
Leeds and
York
1525
328
65
78
1
4854
702,900
South West
Yorkshire
1251
Not provided
117
3
1
6550
713,900
Central and
North West
London
914
Not provided
Not provided
4
4
5899
780,600
Oxford
778
287
225
Not provided
0
5979
401,800
North East
London
84
56
Not provided
3
3
6153
568,100
Injury Data
Incidents of physical
restraint
Incidents of physical restraint
resulting in physical injury
Percentage
5 Boroughs
1415
169
11.9%
Cheshire & Wirral
1538
88
5.7%
Dorset
568
35
6.1%
Dudley and Walsall
121
19
15.7%
Humber
334
23
6.8%
Lancashire
3018
200
6.6%
Leeds and York
1525
78
5.1%
Mersey Care
1347
94
6.9%
NTW
2660
36
1.3%
South Essex
833
56
6.7%
Sussex
247
17
6.8%
Use of Restraint
• The use of physical restraint in any of our services setting is always
used as the last resort after all other options have been exhausted.
• The vast majority of situations are successfully resolved safely
through effective staff engagement, communication and deescalation skills.
• Most restraints do not involve the use of the prone (face down)
position.
• Restraint techniques include the standing, sitting, supine (face up)
and prone position, with the prone position used only as an absolute
last resort and for the shortest possible time.
• The use of any restraint is continually risk assessed on an individual
and on-going basis with the safest and most proportionate response
used.
• Most incidents are resolved within minutes.
Use of Restraint
• The techniques are not designed to cause pain and have been
independently medically risk assessed.
• These types of techniques are used by the vast majority of mental
health and disability NHS trusts and they are in line with current best
practice and national guidance.
• Our staff are given extensive training in recognition, prevention and
de-escalation skills as well as methods of physical restraint and the
risks associated with the use of physical restraint to ensure that they
can manage episodes of violence and aggression in a safe,
supportive, dignified and professional manner in line with national
guidance and the best available evidence.
• The trust is part of a national best practice association GSA
• The trust has been asked to take a leading national role in PMVA
Action Plan
•
•
•
Establish a Task and Finish Group with clear Terms of Reference to review
the use of physical restraint across the Trust. Led by the Executive Director
of Nursing and Operations membership of the group will include: Group
Nurse Directors; Clinical Director, Forensic Service; Clinical Director,
Children and Young Peoples Service; Directorate Manager, Stepped Care;
Chair of the Trust MVA Group; Head of Training; two MVA Trainers; Nurse
Consultants from the Specialist Care Group; Deputy Director of Clinical
Governance; Head of Safety; Head of Safeguarding Children; Director of
Clinical Effectiveness; Patient Safety Manager; and external experts as
required.
Undertake a peer review of the care records of those patients who were
restrained in the prone position. The Terms of Reference will set out clearly
the areas to be reviewed and the expertise required.
Review the Trust’s MVA training programmes to ensure they are
underpinned by best available evidence and current national guidelines.
Action Plan
•
•
•
•
•
•
Review the Trust Prevention and Management of Violence and Aggression
policy and PGNs to ensure they are in line with best available evidence and
in line with current national guidance.
Undertake an extensive literature review to inform actions 3 and 4.
Undertake a full review of the Trust’s reporting process in relation to the
Prevention and Management of violence and aggression.
The Task and Finish Group will identify and co-ordinate examples of good
practice from other organisations to support and inform this review.
Provide regular updates to the Board of Directors, Senior Management
Team, and the wider organisation.
Complete all actions within six months with a final report with
recommendations to the Senior Management Team and Board of Directors.
Response from a Carer
I’ve read this morning on the BBC site about face down restraint and the high figures in NTW trust – I’m fairly certain that some of those figures
include X, and though not used recently has been used in the past.
Obviously Restraint of X is a matter for the MDT involved in X’s care however could I say I support the use of “face down” - to me (as an engineer )
legs and arms naturally bend forwards so if you want to stop them working then put a block (ie the floor) in front of him if you were to use face up
restraint then the block will have to be people and staff and you would probably have to use more and stronger tactics to restrain rather than less
and have a greater risk of injury to staff and X.
The best restraint is to never have to use one at all - that is done by environment and behavioural modification – something that the Unit has done
with great expertise, but the staff (and X) need the protection of the sanction of restraint when absolutely required and to me the best restraint to
use is one that will immobilize X with the minimal amount of people and the minimal amount of time with the minimal risk of injury to staff and X. I
have no doubt at all that this view is shared by the MDT team and of course they should decide the method.
I have said in the past that I would find it extremely difficult to approve restraint or medication for X but I wholeheartedly agree with its use. I am
forever grateful for the Consultants in charge for taking and making the decision and the protection that the MHA gives. However if you are
reviewing restraint based on this reporting I would ask that you consider my views as one of support for restraint.
Please all keep up the good work, I hope that face down restraint is never used on X again, but I hope it is for the right reasons – that X doesn’t
need restraint. However I would wholeheartedly support the Unit in any restraint they feel they need to use including face down which to me as a
bystander seems to be the most sensible method of immobilising head, arms and legs as you are stopping them from moving in their natural
direction very easily.
X is my son, I want to see the minimal pain and suffering for him and I am convinced the staff do also, however staff need and deserve the best
protection that they can be given, the report seems to be sadly missing this fact.
I am completely happy for this to be shared amongst staff members if you wish so that they know they have my absolute support in any restraint
they use
Names removed to protect patient confidentiality
Questions