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Pioneering guidance on mental health restraint when police involved

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New guidance has been published to ensure people with mental health problems get “help not harm” when police are summoned by healthcare professionals to deal with violent incidents.

The Memorandum of Understanding, which is aimed at both healthcare staff and police officers, sets out clearly for the first time when and why police should be called out to mental health and learning disability settings, and their role in dealing with difficult situations.

“This guidance offers clarity for police officers and mental health staff alike”

Ian Hulatt

Co-ordinated by the College of Policing, the guidance has come out of two years of work by an expert group chaired by Lord Carlile of Berriew, with the involvement of more than 30 health and care organisations and people who have experience of being restrained.

“Being restrained by police in these settings can trigger psychological trauma, especially for people with previous experience of physical or sexual abuse,” said Lord Carlile.

“The work we have done means every mental health provider in England and Wales now has a single document which clearly outlines their role and the role of others,” he said. “This means the public will get the care they need, rather than control, and at the right time.”

The guidelines outline police powers, the law, the responsibilities of healthcare providers, and cover the use of physical restraint and force.

The guidance makes it clear there are significant risks when using physical restraint and advocates the use of verbal and de-escalation skills by all concerned, including the police, wherever possible. It also spells out the need for good communication between all parties.

“It is vital there is clarity across all organisations about how to manage difficult situations”

Paul Farmer

The document has been endorsed by the Royal College of Nursing, the Royal College of Psychiatrists, mental health charity Mind, the Faculty of Forensic and Legal Medicine and the National Police Chiefs Council.

“The police service and healthcare providers have experienced incidents in which patients under restraint have died,” it stated. “Where agencies find themselves working in close partnership in fast-moving situations in which there may be danger, the potential for unclear communication, conflict between organisations’ guidelines and different restraint practices have the potential to increase the difficulty in ensuring a safe and effective outcome.”

The document highlights examples of situations where a police response would be appropriate, such as if a patient has a weapon and is threatening staff and other patients, or their violent behaviour means there is a real risk someone could get seriously hurt.

Memorandum of Understanding

Pioneering guidance on use of restraint by police

Lord Carlile of Berriew

Other example situations include causing serious damage to property, or have taking someone hostage and threatening to harm them.

It also features real-life examples of good practice where police were called on, communication was clear and incidents were dealt with successfully.

The document explains what action to take if healthcare staff are concerned about the way an incident was handled.

“Where the senior nurse has concerns about the appropriateness of the police response, they should escalate that to the duty inspector and to their own managers,” said the guidance.

The Memorandum of Understanding document encourages police and healthcare professionals to review and learn from incidents together.

Meanwhile, it said all health providers should review the prevention and management of violence and aggression training provided for staff, and look at all incidents in 2016 when police were called for emergency assistance.

Ian Hulatt

Ian Hulatt

Ian Hulatt

“This guidance offers clarity for police officers and mental health staff alike, in what are often very challenging circumstances for everyone concerned,” said Ian Hulatt, professional lead for mental health at the RCN.

“It will help ensure the safety and dignity of patients, as well as the medical staff and police officers responsible for providing the care they need,” he said.

Paul Farmer, chief executive of Mind, also welcomed the guidance, which will now be fed into local mental health Crisis Care Concordat action plans.

“When someone is having a mental health crisis, they become frustrated, frightened and extremely distressed, and when someone is at their lowest point, they need help, not harm,” he said.

“Physical restraint should only be used as the last resort, so it is vital there is clarity across all organisations about how to manage difficult situations appropriately,” he added.

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