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Massive variations in NHS use of patient restraint revealed


Nearly 40,000 incidents of physical restraint on mental health patients in England were recorded in one year - with more than 3,000 in the “dangerous” face-down position - according to figures released by a charity.

Mind said data obtained under the Freedom of Information Act showed 39,883 recorded incidents of all kinds of physical restraint in mental health trusts during 2011-12, resulting in at least 949 injuries to people with mental health problems.

The charity said there was “huge variation” between trusts in the use of all types of physical restraint.

Surrey and Borders Foundation Trust reported just 38 incidents over the year while Tees, Esk and Wear Valleys Foundation Trust reported 3,346.

The charity said the figures for overall physical restraint incidents, including face-down incidents, were compiled from answers provided by 51 mental trusts.

More than half of the responding trusts, or 27, said 3,439 of the incidents were of face-down restraint, a potentially life-threatening form of restraint, according to Mind.

Northumberland, Tyne and Wear Foundation Trust recorded 923 incidents of face-down restraint and Southern Health Foundation Trust 810, according to the charity’s figures.

A separate survey by Mind of 375 frontline healthcare staff involved in physically restraining people with mental health problems, showed almost a quarter, 22%, had not had face-to-face training on physical restraint techniques in the last 12 months.

More than four in 10, or 42%, according to the charity, said that with hindsight, they felt that restraint had sometimes been used “inappropriately”.

Paul Farmer, Mind chief executive, said: “Physical restraint can be humiliating, dangerous and even life-threatening and the huge variation in its use indicates that some trusts are using it too quickly.

“Face-down restraint, when a person is pinned face-down on the floor, is particularly dangerous, as well as extremely frightening to the person being restrained. It has no place in modern healthcare and its use must be ended.”

Deborah Coles, co-director of the campaigning group, Inquest said: “Despite the plethora of restraint-related recommendations from inquests and inquiries into deaths it is shocking that restraint is still relied upon at such disturbing levels.”

A statement from Northumberland, Tyne and Wear Trust said: “Reasons for restraint can include a patient being violent or aggressive to either themselves or others with a small percentage of patients requiring high levels of restraint due to the complex nature of their illness.

“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 the recorded incidents of restraint.

“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.

“As one of the largest mental health and disability trusts in the country, covering two large cities in the North East, we recognise we are one of the highest reporters among those organisations who responded to Mind’s Freedom of Information request.

“Our recorded statistics 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 to areas without such specialist services.”

Lesley Stevens, clinical director of mental health services at Southern Health Foundation Trust, said: “We welcome Mind’s report into the use of restraint in mental health services, and hope that it will contribute towards more robust national guidance in the future.

“We fully recognise that, whatever methods are used, there is no completely safe restraint position or duration.

“When interpreting the information in the Mind report, it is important to take into account the relative size of the different organisations involved, the number of patients involved, and the type of services that are provided, as there is a large variation from trust to trust.

“Southern Health is one of the largest providers of mental health and learning disability services in England.

“We also support people who have been involved in the criminal justice system and other highly complex and challenging people who require very intensive care.

“Our figures for restraint are comparable with other trusts which provide similar regional and national services.

“Our staff are trained to understand the triggers which can lead to aggression so they can act early to avoid the need for physical restraint.

“They are also trained how and when to use physical restraint in the safest possible way, and for the shortest possible time, when it does become absolutely necessary.”

Jo Young, of Surrey and Borders Partnership Foundation Trust, said: “We welcome this report from Mind and their call for national standards to reduce the instances of physical restraint on mental health wards.

“Ensuring people who use our services are treated with dignity and our culture of mutual respect on our wards are both core to our service delivery.”


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Readers' comments (3)

  • Ok, this is data, but out of context data. It leads to more questions than answers. Do the trusts that have higher numbers of restraint have better reporting mechanisms or culture? Do all trusts record the number of restraints that don't end up in full face down restraint?

    The empolyer has a responsibility to protect its workforce from harm (H&S at Work) and so needs to prepare and train staff to deal with situations that involve violence to protect themselves and others.

    what about the number of staff injured by acutely unwell people? what should we do instead of restraint? Chemically restrain patients? This would surely lead to higher levels and possibly longer term harm. Perhaps the days of the padded cell are coming back? I for one will be leaving the profession at that point.

    I don't know whether in other places individuals over restrain but I feel very strongly that restraint is only used where alternatives have failed.

    Nurses come into the profession to help, not to become a recepticle of violence for a variety of individuals some with illness some with behavioural issues and some because it is a means to an end.

    I have only ever been involved (and the training emphasises this) in carefully considered, last resort restraints where everything else has been tried and failed and to not act would be neglect.

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  • I fully support the above comments. Far too many staff, mostly nurses, have been seriously injured when restraining patient's Nobody wants to use restraint. It is an unfortunate but necessary practice to protect patients (consumers/service-users) from hurting somebody else. There are 2 or more sides to every story; lets get the full facts before laying even more blame on over worked nurses/assistants in understaffed services, and instead of criticizing, come up with realistic, sensible and practical alternatives.

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  • Tinkerbell

    I agree with steve and above anonymous. I dislike restraint intensely but have always committed fully when needed. I have seen restraint used when it shouldn't have been used and not used when it should have been. I am glad i no longer have to do it anymore. I hope it is used much less now and only after serious consideration as the truly last resort.

    I was seriously assaulted in 1996 in a ward round, knocked unconscious by a young violent adult weilding a coffee mug, which was smashed to smithereens over the back of my head and was embedded in my scalp. This left me partially deaf with permanent tinnitus due to neuro sensory damage to the left side of back of head. I had my scalp glued in several places.

    All staff need to be properly trained, only prepared to use it as a last, fully considered resort when all else has failed,commit and resolve in a timely manner but as Steve above has said until someone can come up with an alternative sensible, practical alternative we still have to protect ourselves and others from harm.

    I want to have more than a bag of jelly babies to offer someone who is about to maim another human for the rest of their life if not kill them. What an outcry if we just stood by. Damned if you, damed if you don't.

    Perhaps rather than just analysing statistics these critics can come to units and see for themselves when and why it is used and then reflect and report back.

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