Face-Down Restraint Still Common in Mental Health Despite Guidance to the Contrary

Face-down physical restraint is still being used in mental health wards in England, despite the government and NHS indicating that the practice should be frowned upon.

The usage of the practice is considered particularly dangerous as it can restrict the breathing of a patient.

Yet despite new guidelines indicating that face-down restraint should be phased out, the incidence of it occurring in the mental health system dropped only slightly over the last two years.

In 2013-14, 22.4% of recorded incidents of restraints were face-down, falling to 18.5% by 2015-16.

Nonetheless, despite the fact that the NHS has requested this form of restraint to be significantly reduced, some trainers of healthcare staff believe that it can be the only appropriate way of ensuring that both staff and patients are kept safe.

The total number of recorded restraints rose by 16.6% from 2013-14 to 2015-16, indicating the dangers that staff face in the mental healthcare system, although it is believed that improved reporting could also contribute to this discrepancy.

Figures were collated following a Freedom of Information request by Norman Lamb, the Liberal Democrat MP for North Norfolk and former Health Minster, who introduced the new guidance in April 2014.

Naturally Lamb will be disappointed with the fact that face-down restraint seemingly remains a central part of the medical healthcare system.

And the MP commented on the issue, suggesting that there is considerable room for improvement.

“I find it immensely distressing, to be honest with you, because I know the impact that it has on individuals. We have an obligation to those individuals to do better than this.”

NHS England’s national clinical director for mental health, Prof Tim Kendall, however suggested that there has been some improvement, even if the rate of change has not been as rapid as might have been hoped.

“We are going in the right direction, but there’s a lot of other things that we need to do. When you go to an inpatient unit, you are commonly being restricted. And that’s bound to produce a reaction in people, and it’s important for all of us to make sure that doesn’t end in restraint.”

Kendall also suggested that trying to stop the practice sent an important signal about “humanising and ethicising and professionalising” mental health services in England.

“For those trusts not changing things in a positive way, or worse [where] still things are not improving, they really need to take note of this. These are real human rights and ethical issues that they should be thinking about.”

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