Use of Restraint
In October 2011, Professor Richard Shepherd presented a review of medical theories on restraint deaths. The report highlighted that certain groups were more vulnerable to risks associated with restraint – both intrinsically, and because they are more likely to be restrained. These groups were those with serious mental illness or learning disabilities; those from BME communities; those with a high body mass index; men age 30-40 years and young people (under the age of 20).
The report was the first body of knowledge on the medical dangers of using restraint. In the first instance, the Panel was particularly interested in focusing on reporting mechanisms for restraint deaths.
Use of force data collation by the Police
The report highlighted the lack of any national mandated requirement for the collation of use of force statistics by the police and this was echoed in the HMIP annual report for 2010/11. The IAPDC called for local police forces to submit use of force and restraint statistics to a suitable central police body on an annual basis for monitoring and analysis purposes, and arranged meetings which were attended by the IPCC, HMIP and HMIC, College of Policing and the Association of Chief Police Officers (ACPO) to progress the Panel’s work in developing a justification for police forces to submit use of force data.
The revision of ACPO Guidance on the Safer Detention and Handling of Persons in Police Custody as Authorised Professional Practice (APP) disseminated by the College of Policing in 2014 provided an opportunity for ACPO to consider how forces record use of force data and have worked with the IAPDC to determine the data requirements to be included in the APP. The consultation on the revised APP launched on 24 June 2014 and further draft guidance was published on 31 July 2015.
Common Principles for Restraint
Another key strand for the Panel was the formulation of a common set of principles for custody sectors on the use of restraint. Standards were developed in conjunction with agencies representing Immigration, prisons, health, youth justice, police and the Restraint Advisory Board, and were further amended in consultation with the CQC, DH, Institute of Psychiatry and Royal College of Nursing in August 2012 to ensure that they were also relevant to mental health settings.
The Common Principles on the Safer Use of Restraint were published in July 2013. They covered expectations for restraint training; management of restraint incidents; medical conditions relating to the use of restraint and governance procedures such as de-briefing and data collation. After initial concerns from organisations, recent feedback has been positive and the Panel expects that they will be complying with the principles and incorporating them into policy.
Restraint in Mental Health Settings
An obstacle to gaining acceptance of the principles had been questions about their applicability to places where patients are detained under the Mental Health Act. The Panel was, therefore, pleased that the Department of Health announced its Positive and Safe Programme in 2014. This was a two year programme designed to reduce the use of restrictive interventions in health and care settings. The guidance provided the framework for services to develop a culture change in which the use of restrictive interventions is always a last resort and a commitment to work towards ending prone restraint.
In early 2015 DH revised the Mental Health Act Code of Practice which applies to all providers and requires them to take responsibility for the use of restrictive interventions by:
- Producing restrictive intervention reduction plans
- Deciding the type and level of restrictive interventions that should be used in their organisation
- Ensuring that staff have appropriate training but that their overall training includes a focus on the legal framework, de-escalation and understanding the cause of challenging behaviour.
The Panel welcomed the development of this piece of work and are pleased to note that both restraint techniques and training will be accredited.
Terms of Reference
The working group considering the issue of the use of physical restraint included:
- Reviewing the statistics on the number of restraint related deaths that have occurred within state custody over the last ten years and the circumstances of these to gain an understanding of the scale of the issue and identify any common themes.
- Reviewing the policies and guidance governing the use of restraint across the different custody sectors and the training provided to staff. Attempting to identify the points of correlation and discrepancy between sectors in relation to restraint and highlight the reasons why different approaches were adopted.
- Undertaking a short analysis of current medical theories and concepts about restraint related deaths.
- Identifying good practice and learning in relation to the actual use of restraint techniques and the training provided to staff and explore how this might best be shared across the different custody sectors.
- Considering whether cross sector guidance on the principles of the use of restraint would be useful and if so use the findings of this work to feed into the development of this document, which would be taken forward as part of the IAPDC’s longer-term work programme.