Mental health patients are being pinned face down by staff thousands of times a year, despite ministers and health experts repeatedly warning that it is dangerous.
Prone restraint, in which someone is held chest down to defuse an incident, has been a source of controversy for years and been involved in the death of a number of people with mental health problems.
In 2014 the then coalition government responded to widespread concern about its use when it acknowledged that it “can result in dangerous compression of the chest and airways and put the person being restrained at risk” and told mental health units in England to phase it out.
But new NHS figures obtained by the Liberal Democrats show that face-down restraint was used 5,247 times during 2023 and 3,732 times in the first 10 months of this year alone. “These findings are alarming,” said Danny Chambers MP, the party’s mental health spokesperson.
The National Institute for Health and Care Excellence (Nice) and Care Quality Commission, the NHS care regulator, both advise mental health care providers to avoid using prone restraint and, when they do use it, to do so for the shortest time possible.
And government guidelines from 2021 are clear that “there must be no planned or intentional restraint of a person in a prone or face-down position on any surface, not just the floor”.
Holding someone face down is one of a number of different forms of manual or chemical restraint that personnel in mental health hospitals use when an inpatient becomes disruptive, aggressive or violent. They can also hold the person, put them in handcuffs or tranquillise them.
The Mental Health Units (Use of Force) Act 2018 was intended to prevent the “disproportionate and inappropriate” use of any type of restraint in order to protect patients’ dignity and respect. It was also known as “Seni’s law” because it was prompted by the death of Olaseni Lewis, a Black man who died in 2010 after being restrained by police officers as he was suffering a mental health crisis while being treated in an inpatient unit in London. The then Conservative administration delayed introducing the legislation for three years.
Freedom of information responses to the Lib Dems by 30 of England’s 54 NHS mental health trusts show that use of any form of restraint continues to be widespread. In all 16,186 patients were restrained in 2022, 16,920 in 2023 and 14,642 in the first 10 months of this year.
Those trusts recorded 900 cases during 2023 in which a patient was injured as a result of being restrained and another 702 between January and October this year. Staff were injured 2,278 times in 2022 while applying restraint and on 1,885 occasions during the first 10 months of this year.
Some trusts appear to use restraint, and specifically face-down restraint, much more than others. For example, the East London mental health trust used some form of restraint 3,831 times in January to October – the most in England – whereas the equivalent body in Cambridgeshire and Peterborough did so 147 times.
Similarly, Cumbria, Northumberland, Tyne and Wear trust used face-down restraint 495 times between January and October while Cornwall Partnership did so just four times.
“Physical restraint can cause significant distress for vulnerable patients and leave staff with severe injuries. That some institutions are physically restraining mental health patients far more than others shows that our NHS services have been neglected and overlooked for too long,” said Chambers.
It is “particularly worrying” to see restraint being used so persistently despite Seni’s law having finally been implemented three years ago, he added. He urged ministers to launch an investigation into the situation, which has arisen because the last Tory government failed to improve mental health care and “some of the most vulnerable people in our society are now paying the price”.
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Andy Bell, the chief executive of the Centre for Mental Health thinktank, said: “It is deeply disturbing that restraint is being used so frequently in mental health services despite legislation to reduce the use of force and ongoing quality improvement work.
“Inpatient services are working under enormous pressures, with occupancy rates in some wards above safe levels, chronic staff shortages, and outdated facilities that make it harder to provide good care.” Alternatives to stays in mental health hospitals are needed urgently, he added.
Mind, the mental health charity, says that: “Healthcare staff do a challenging job and have to intervene where a person is a risk to themselves or others. However, restraint should only be used as a last resort, when prevention and de-escalation have not worked.”
A Department of Health and Social Care spokesperson said: “This data is incredibly concerning. Patient safety is paramount, and anyone receiving treatment in an inpatient mental health facility deserves safe, high-quality care, and to be treated with dignity and respect, with face-down restraints only ever being used as a last resort.
“Our mental health bill will ensure that people with the most severe mental health conditions receive better, more-personalised treatment that is appropriate, proportionate and compassionate to their needs.
“We will also work with the NHS to transform care and recruit 8,500 more mental health workers across children and adult services to reduce delays and provide faster care.”
Source: theguardian.com
