Youth justice: Review calls for tighter regulation of use of restraint

A long-awaited review of restraint in the juvenile secure estate today called for its use to be much more tightly regulated, but said painful techniques should not be banned.

Former social services directors Andrew Williamson and Peter Smallridge, who were commissioned by the government last summer to review the use of restraint, made 58 recommendations to improve the system, most of which were accepted by ministers today.

The Department for Children, Schools and Families and Ministry of Justice announced £4.9m in funding to ensure the implementation of the reforms over the next two years, and said Williamson and Smallridge would oversee this process.

Six principles of restraint

The departments accepted their call to re-examine legislation and guidance on restraint against six principles, including that force should only be used as a last resort and to prevent the risk of harm.

Currently, legislation allows staff in secure training centres to use force to prevent trainees from escaping or damaging property, as well as injuring themselves or others.

Ministers will also carry forward recommendations to set up an accreditation scheme to cover approved restraint techniques, training and trainers, which would be the only ones that could be used in the secure estate.

Techniques would be approved by an accreditation panel, including paediatricians and child psychiatrists, and underpinned by a research base on the medical safety of restraint methods.

Banning existing techniques

Williamson and Smallridge also called for a number of existing techniques to be banned, with all of these accepted by ministers.

These included the double basket hold and the nose distraction technique, which had been used in STCs until they were suspended from use last year, after medical experts raised concerns about their safety. 

The latter – which involves an upward blow to the septum – was used on Adam Rickwood hours before he was found hanging in his room at Rainsbrook STC in 2004. Criticisms of the use and monitoring of restraint raised at Rickwood’s inquest last year prompted ministers to commission the review last summer.

Justifiable pain

But Williamson and Smallridge concluded there were circumstances where the use of painful techniques could be justified, despite being “irreconcilable” with the UN Convention on the Rights of the Child, to which the UK is a signatory.

While they proposed separate systems of restraint for STCs and young offender institutions – mirroring current arrangements – ministers said they would introduce the same system for both settings, based on Williamson and Smallridge’s proposals for STCs.

This would involve the use of wrist holds as legitimate, painful techniques. However, a secure setting would only be able to employ them where:-

• They had been authorised at senior management level following a risk assessment and signed off by the healthcare department.
• Risk assessments has been subject to weekly review.
• De-escalation and approved restraint techniques had been tried first in individual instances.

The review also said that all incidents of painful restraint should be reported to the Youth Justice Board and local safeguarding children boards for external scrutiny.

Unpopular proposals

However, despite these safeguards, Williamson and Smallridge admitted their proposals would be “unpopular”, including with the UK’s four children’s commissioners.

The review made a number of other recommendations to improve the monitoring and regulation of restraint:-

• The government should set up a Restraint Management Board to monitor policy on restraint, chaired by a minister.
• All establishments should record incidents involving restraint within 24 hours and produce analyses of the use of restraint at least once a month.
• YOIs and secure children’s homes should join STCs in submitting reports to the YJB on warning signs occurring during restraints.
• The YJB should have effective sanctions to back up its monitoring of restraint, including reporting incidents to LSCBs.
• A formal debriefing should take place with every restrained young person within 48 hours of the restraint, and they should have access to independent advocacy for this.
• LSCBs should be able to scrutinise the restraint policies of secure establishments in their areas and report at least annually to the YJB on the use of restraint locally.
• Ofsted and the prisons inspectorate should consider establishing a joint unit which specialises in the inspection of restraint regimes and practice.
• All secure settings should devise strategies to reduce the use of restraints.

While the government accepted those recommendations in full, it failed to back others, including:-

• The YJB should commission regular independent audits of restraint reduction strategies. The government only backed this in principle. It said Smallridge and Williamson would examine restraint reduction strategies in monitoring implementation of the review’s recommendations, while the YJB would monitor progress through existing processes.
• Ensuring all restrained young people are seen by a healthcare professional within 30 minutes of a restraint. The government said secure establishments would need to “form a judgement” as to whether this was appropriate in individual instances.
• All injuries resulting from restraint should be photographed and recorded on a body map. The DCSF and MoJ said they were doubtful about the “purpose, value or appropriateness” of photographing injuries routinely and said this should be left up to individual establishments.
• Independent advocates should report annually to the YJB on debriefing sessions. The government said they should be free to feed back to the YJB but routine reports “might not fit easily with their primary duty to represent the young person”.

The review also made a number of recommendations to improve the training of staff in the secure estate, including:-

• All staff should have comprehensive training in awareness of risk factors for restraint, monitoring of warning signs and the need to take action quickly. This should include risk assessments, recognition of distress among young people during a restraint and basic resuscitation training.
• All secure staff should receive a core module of training, including restraint, before being allowed to work with young people.
• Refresher training in restraint should be more frequent – ideally every six months.

These recommendations were backed by the government. The review also called for the development of an NVQ level 3 qualification for staff in juvenile settings. In response, the government said it was reviewing vocational training for this group of staff and the introduction of an NVQ was one option for reform.

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