Special Report
More mental health patients will die when they are physically
restrained because the government has failed to introduce a time
limit for its use, experts have warned, writes Sally
Gillen.
| David Bennett |
Widespread criticism has greeted the publication today of guidelines by the National Institute for Clinical Excellence that fail to impose a three-minute time limit – a key recommendation of the inquiry into the death of David Bennett.
Bennett died in 1998 at Norvic Clinic, Norwich, after being restrained face down for 25 minutes by three or four nurses.
Inadequate response
His sister Joanna Bennett, who has led calls for reform of the use
of ‘prone’ restraint, said: “Mental health
services continue to be in denial about critical incidents and
deaths associated with control and restraint.”
Co-director of Inquest Helen Shaw added: “The guide is a profoundly inadequate response to the appalling death of David “Rocky” Bennett…it is particularly shocking that there is no reference that alerts practitioners to the deaths that have occurred following restraint and the special dangers posed by prone restraint.”
Figures collected by the Mental Health Act Commission show that between 1997 and 2000 four people died after being restrained.
"Just as important"
Speaking ahead of the publication of the guidelines last week,
mental health tsar Louis Appleby defended the decision to reject
the three-minute maximum, arguing its requirement for “the
shortest time possible” was “just as
important”.
| Tsar Louis Appleby |
But senior race relations and health consultant at human rights organisation 1990 Trust Matilda MacAttram described it as “an insult”.
Dr Richard Stone, who sat on the inquiry panel, said it was
“wishy-washy”.
“In the Bennett case a senior charge nurse had hold of his
[Bennett’s] left arm. He had been through all the training.
He should have just sat near his head making sure his airways were
clear.”
“It is crucial to have the three-minute rule because people often forget their training when they panic because they are in a crisis”
“People will go on dying in these circumstances until the NHS has the courage to act on this, which it must do now,” added Stone.
The guidance says:
• During a physical intervention one team member should be
responsible for protecting and supporting the head and neck, where
required
• The team member who is responsible for supporting the head
and neck should take responsibility for leading the team through
the physical intervention process and for ensuring the airway and
breathing are not compromised and that vital signs are
monitored
Key priorities for implementation –
Prediction
Mental health service providers should ensure there is a full risk management strategy for all their services
Training
All service providers should have a policy for training employees and staff-in-training in relation to the short-term management of disturbed/violent behaviour
All staff whose need is determined by risk assessment should receive ongoing competency training to recognise anger, potential aggression and risk factors. Training should include ways of de-escalating violent behaviour
Staff who employ physical intervention or seclusion should as a minimum be trained in Basic Life Support.
Working with service users
Service users should have access to information about what their rights are in regard to consent to treatments, complaints procedures and access to independent help and advocacy
Service users identified to be at risk of disturbed or violent behaviour should be given the opportunity to have their needs and wishes recorded in the form of an advance directive.
Rapid tranquilisation, physical intervention and seclusion
Rapid tranquilisation, physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user.
The intervention selected must be a reasonable and proportionate response to the risk posed by the service user.
Violence – The short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments www.nice.org.uk
The Bigger Picture on Mental Health
