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
    Gillen.

    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
    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


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