Face-down restraint in mental hospitals: Mind are to be congratulated

I’ve been quick, in the past, to criticise the mental health charity Mind when they have done things of which I disapprove. Simple justice demands I should be as quick to applaud when they do something of which I approve.

In that light, I want to put on record my heartfelt appreciation for Mind’s work in seeking out information about the barbaric practice of face-down restraint in mental hospitals, and to congratulate them for their success in securing a great deal of high profile media attention. Three stories on the front page of the BBC News website (an article, a video demonstrating the technique, and a powerfully-worded comment piece), together with a broadcast report that aired on the News at Ten last night, add up to a remarkably high profile for a mental health story. And that’s before the “me, too” copies of the story in the print media are taken into account.

This is extremely important work, and I am more pleased than I can say to see Mind stepping up to the plate in this way. I had thought they had become so caught up in their witless and counter-productive campaigns against the bizarrely trivial problem of “stigma”, and so comfortable in their annual round of glamorous showbiz parties which achieve nothing, that they had quite lost sight of their responsibility to defend the interests of the most vulnerable and profoundly unwell people. I am extremely glad to have been proved wrong. (Although I note from their list of current campaigns that they still rate their anti-“stigma” Time to Change campaign to prevent people from saying mean things about the mentally ill as more important than their oh, so quiet campaign against the combined benefit and healthcare cuts which are driving the mentally ill to despair. Still a pretty warped set of priorities there, I feel.)

Mind's current campaigns as of 19/06/2013

Mind’s current campaigns as of 19/06/2013

Turning to the focus of the campaign, the use of face-down restraint is horrific. People restrained in such a way are at significant risk of suffocating to death. Even where they survive, they do so having endured an experience equivalent to those methods of torture which induce fear of suffocation, and which are illegal under English, European and international law.

It should be noted that the practice is wholly unnecessary, and completely lacking in any clinical justification whatsoever. Mind’s research demonstrates that some mental health trusts have banned face-down restraint with no negative consequences, even as other trusts resort to it on a routine, daily basis. In fact, since face-down restraint is an unavoidably traumatic experience for the person being restrained, the technique is profoundly counter-therapeutic – it cannot help but increase anxiety, and could even trigger post traumatic stress disorder (a serious mental illness in its own right) in those who are subjected to it.

Mind have responded to this horrifying catalogue of abuse with rather weak calls for ‘national standards’ and better ‘training’ for the perpetrators, but I believe it’s important not to mince words here. Since there is demonstrably no legitimate reason to subject patients to face-down restraint, the practice can only be described as assault and, in those cases when it results in death, murder. Mental health professionals have a duty to prevent the individuals under their care from harming themselves or others, and can legitimately employ the minimum of necessary force when there is no other way of securing that objective. But that does not mean that they are or should be given carte blanche to assault their patients.

It is important to consider that, in many (if not all) cases, the people on the receiving end of this abuse will be involuntary patients. That is to say, they will have been reduced by an Act of Parliament to the legal status of children – subject to the whims of the “adults” (i.e., mental health professionals) who are supposed to look after them, in grave danger of suffering abuse if those “adults” exploit their position, and unable to escape the clutches of their abusers unless they can persuade another “adult” that they are being abused. (Which is almost impossible, since mental patients are by definition considered to be unreliable witnesses to their own experiences.) Because involuntary psychiatric patients are prevented by law from defending their own interests, it is of critical importance that the law offers them the very highest standards of protection in return. It is for this reason that I would welcome clarification from the government that abusive restraint practices in mental hospitals are a criminal offence.

Some have suggested that the most worrying aspect of this story is that many mental health trusts were unable to provide figures on their use of face-down restraint, even though they are required by law to maintain detailed written records of every instance of restraint. I agree that is cause for concern, since it makes assessing the scale of the problem impossible, and also suggests a worryingly lackadaisical approach to record-keeping in general: if they’re failing to record incidents so serious a patient has to be restrained, what other clinically significant information are they forgetting to write down? But for my money the most worrying aspect of the story is to be found in the comments left under the BBC news story.

Several of the most highly recommended comments are from mental health professionals (or, at least, from people who purport to be such), and they make for worrying reading.

From someone calling themselves schpartacus:

As an ex psych nurse in the special hospital system, face down restraint led to fewer injuries for all. Having been bitten, spat at, punched, head butted, kicked, hair pulled etc, this proposed ban is nothing short of ridiculous and echoes the normal system whereby those who don’t have to actually deal with the harsh realities tell those who do how to do it. It is madness. Spend a shift or two 1st

From a user called Zedboy:

I advocated face down restraint on many clinically appropriate occasions with violent patients. It kept paints safe, it kept staff safe, it kept visitors safe. On some occasions, with severely challenging patients, it is the last and best resort and needs to be retained.

Love to see the PC dogooders try and cope on an under staffed ward without it…injuries and abuse would escalate horrifically.

From seymourf:

Face down restraint is unpleasant for everyone involved, but is used appropriately only to control situations which would in and of themselves pose a greater risk. Staff receive training to manage risk of injury and respiratory failure. Restraining service users in a supine position poses significantly increased risk associated with physical mechanics. Think about it for a minute.

From JohnnyLeeds:

This man [health minister Norman Lamb, who wants to understand why some trusts have banned face-down restraint with no negative consequences while others use it every day] is a clown. Face down restraint is always a last resort and like physical restraint itself in my 20 year experience is only used as a last resort. The question is, what was the individual doing prior to the restraint being initiated? In the vast majority of cases they were involved in violent conduct where staff had to take action to resolve the situation and maintain a safe environment.

All of these people claim to be, or to have been, mental health professionals, yet none of them engage with the central issue: that if some hospitals, faced with the same difficult and challenging patient behaviours, can manage the risks without ever resorting to face-down restraint then every hospital can do the same. All of them fail to acknowledge the difference between the occasional deployment of the minimum physical force required to keep themselves and others (including the patient) safe, and the routine deployment of abusive conduct that carries a significant risk of suffocation and death. At least one of them fails to understand that no level of short-staffing, no matter how acute, makes it acceptable for healthcare professionals to intentionally harm their patients.

It’s a moot point point which of these assertions I’m more disturbed by. Is it the assertion that face-down restraint is equally unpleasant for the people doing the restraining as it is the person being restrained? (What – suffocating someone else to death is as bad as being suffocated to death yourself?) Or is it the implication that some risk of a patient stopping breathing during the course of a restraint procedure is acceptable provided that risk is ‘managed’? Or might it be the admission that, in some cases the commenter was personally aware of, patients had been subject to face-down restraint even though they had not been violent and the restraint was not judged necessary to maintain a safe environment?

One thing I do know is that I’m frankly appalled any of these people has ever been put in charge of the welfare of vulnerable people. And I’m extremely glad that Mind have launched so high profile a campaign against this barbaric relic of the bad old days in mental health care. I can only hope that the callous disregard of the mental health professionals I quote above for the well-being of their patients will add focus and urgency to the campaign. We shouldn’t rest until suffocating mental health patients “for their own good” is considered as outrageous as chaining them up.

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4 Responses to Face-down restraint in mental hospitals: Mind are to be congratulated

  1. Pingback: Shocking reports about mental health care | That Socially Anxious Atheist Paranoid Gay

  2. Astrid says:

    You make great points. It’s important that face-down restraint gets banned. Glad htat Mind is campaigning against the use of this measure, but so sorry they’re not maing it (or the cuts) a top priority. I’m so glad to see yoú’re still blogging Aethelread.

  3. Anonymouse says:

    I Disagree, MIND and Norman should be reprimanded and questioned to their misconceived and maligned comments. If it’s a life and death situation and staff need to defend themselves or others then they should be able to restrain without excessive worry to how they are doing it, other than attempting no harm and doing so for minimal time. Restraint may involve science, but it’s application in real life situations is not. No matter how much training will prepare you for such difficult situations
    , real life is different. And yes you make terrible points.

    I wonder how many staff in those two trusts have been physically hurt, reprimanded and prevented legal redress for not rightfully being allowed to defend themselves or others? Mmmm two trusts verses many! I think we should be asking serious questions of those trusts, don’t you? And yes violence is probably on the increase and under reported. And guess what violence perpetrated by patients in mental health isn’t probably as uncommon as you think (just look at what happened when staff got fed up with it in New Zealand). And yes most people with mental health issues will not experience an inpatient stay or are violent, but those that are, probably increasingly do present to inpatient services with behavioural issues and or quasi psychosis (not totally detached from reality or responsibility as you might think).

    I suspect governments and care organisations are not totally telling the truth in fear of their reputations. I think this government and any of it’s associated organisations are going to reap a whirlwind from care staff, if their rights to protect and safety continue to be ignored both by services and government. In my opinion it’s because of both bad government and care management, both private and otherwise that care staff are increasingly whistle-blowing. And so yes I thank Norman and MIND in so much as encouraging whistleblowing further, but not in the way you thought it would. Care staff are starting to stand up for themselves and it’s about time. All that Norman and the rest of the government is doing is taking the blame away from themselves for what is really occurring. And what is really occurring is that care in mental health is falling apart because the government wont fund frontline services and would rather sell the public a show boat with chocolate wheels.

    I think the term individuals with vulnerabilities is better and less patronising than being deemed vulnerable without knowing the specifics of vulnerability. There are individuals with vulnerabilities who in some aspects are consciously and purposefully violent and so are no so vulnerable in that regard. There are such patients who purposefully play the card of vulnerability and go on to perpetrate violence resulting in restraint.

    In short your comments sicken me and are with absolute callous bias so here above is the counter argument that you couldn’t be bothered to ask yourself.

  4. Oh, Aethelread the Unready! Beseech thee to Youtube! http://www.youtube.com/watch?v=xd5b-ZP2QyQ I’m afraid the documentary is in French with German subtitles, but you may still be able to understand what’s going on, or find an English version. I find it an astounding insight into the reality of French mental hospitals – how they retrain patients. The depiction here is quite different to that of “Dont Call Me Crazy,” for instance – less humane…

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