Review into the use of restraint calls for change

An independent review into the use of restraint in the juvenile secure estate released last week stopped short of calling for painful techniques to be banned, but it recommends major changes to how they can be used.

Currently, young offender institutions (YOIs) and secure training centres (STCs) use different systems, but both have been criticised. The YOI’s system was designed for adults rather than juveniles, while it was the deaths of Adam Rickwood and Gareth Myatt while held in STCs that prompted the current review.

The review called for different systems to be used in each setting, but the government has chosen to follow the recommendations it made for STCs for both of them. That means that the painful technique of wrist holds will remain, albeit subject to stricter regulation and monitoring.

The recommendation has been criticised for not outlawing such techniques, but Doctor Brodie Paterson, a lecturer from Stirling University who was referenced in the review as an expert on restraint, says that the crucial factor to minimising pain and the risk of injury is to ensure that whatever techniques are used are placed within an appropriate cultural framework.  

“In essence, physical intervention techniques can be used in a way to promote the safety of a person, or they can be used by staff as an excuse to humiliate the individual,” says Paterson. “The risk isn’t just in the nature of the technique used, it is in the intent of the staff using it – and the way restraint is used varies significantly between these institutions.

“You can change cultures, but it’s a long task. You need skills in facilitation to do that – training senior managers and breaking down barriers between staff.

“I am optimistic, though, having worked with psychiatric hospitals that have turned themselves around.”

Nearly £5m has been provided to implement the review’s findings, including improved training in de-escalation techniques and behaviour management for young people. But will this money fund the right system? Paterson points to evidence that different methods do have different injury rates (he was involved in developing Calm, a restraining method that is currently used in two secure children’s homes).

Indeed, Paterson says that the current lack of a working system in the juvenile secure estate is because different systems haven’t been properly considered and tested. “The problem in part is that the Prisons Service has used in-house expertise in relation to physical management of young people.

“But we’re moving to restraint being understood as a technical, evidence-based practice, and the Prison Service has been caught in the middle of it – the people who they thought were experts, weren’t, in this new sense.”

Paterson, however, says that the promise of a new central accreditation body to test techniques should improve that situation. “One of the good things is that there will be an expert medical review of the techniques used, which is what there should have been in the first place.

“You need to bio-mechanically test them, because the reality of them is quite different when you’ve got a resistant, fit young man who will be expecting its use. You design it, test it, redesign it, test it, and keep doing that.

“But you can’t take this out of the culture. You need to make it a big deal for staff, because it shifts it away from being something we routinely do that doesn’t matter. If you don’t resolve the cultural issues then you could end up with a system that is technically good but that can still be misused.”