Nice restraint guidelines do not go far enough, campaigners warn

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

New Asset  
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

Tsar Louis Appleby

But senior race relations and health consultant at human rights
organisation 1990 Trust Matilda MacAttram described it as “an

Dr Richard Stone, who sat on the inquiry panel, said it was
“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

“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

• 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

Key priorities for implementation –


Mental health service providers should ensure there is a full
risk management strategy for all their services


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

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

The Bigger Picture on Mental Health




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