• 04 October 2019
  • 3 min read

Warning over face-down restraint of people with learning disabilities and autism

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    Nurses.co.uk editorial team
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Staff reported physically restraining patients with learning disabilities or autism 17,685 times at inpatient facilities in England.

Risk of death

Learning disability patients are subjected to potentially fatal face-down restraint an average of 10 times a day, figures show.

Staff reported physically restraining patients with learning disabilities or autism 17,685 times at inpatient facilities in England in the eight months to June, NHS Digital figures show.

The figures cover the period since the NHS started producing them last year. More than 2,500 instances were in the prone position, which is where a patient is pinned face-down against the floor or another surface.

Mental health charity Mind said face-down restraint carries a significant risk of death because of the severe impact it can have on a patient’s ability to breathe, and has called for the Government to ban its use.

Guidance from the National Institute for Health and Care Excellence (Nice) says the practice has been known to kill in as little as 10 minutes.

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Restraint should only be used as a last resort

Dan Scorer, head of policy and public affairs at Mencap, said: “Guidance set out by the Government clearly shows that restrictive interventions should only be used as a last resort.

“However, these figures suggest that it is routine. This is unacceptable and deeply shocking.

“The use of restrictive interventions, including holding people face down on the floor, can exacerbate any challenging behaviour displayed.

“The Government must take urgent action to put a stop to this domestic human rights scandal.”

Medical staff reported using restrictive measures almost 23,500 times over the eight-month period.

This included 1,840 uses of chemical restraint, where drugs not needed for the routine treatment of a patient’s condition are used to subdue or control challenging behaviour.

Seclusion, where someone is confined to a room away from other patients, was recorded 2,130 times, while mechanical restraint, in which devices such as straps are used to restrict movement, was used on 740 occasions.

British Institute of Learning Disabilities - use must be minimised

Ben Higgins, chief executive of the British Institute of Learning Disabilities, said poor quality training could lead to some staff using restrictive interventions as a first option rather than last resort.

He said: “While the use of restraint may on rare occasions be necessary to keep people safe, it can also be highly traumatic and must be minimised.

“Too often, training puts too much emphasis on reactive approaches such as physical restraint, and places insufficient emphasis on human rights, meeting needs, prevention, de-escalation and recovery.”

A Department of Health and Social Care spokeswoman said it was determined to reduce the number of people with autism and learning disabilities in mental health hospitals, and that restraint should only be used as a last resort.

“The Care Quality Commission is undertaking an in-depth review into the use of seclusion, segregation and restraint and we are already taking action on their recommendations,” she said.

A spokeswoman for NHS England said: “Local NHS services are working closely with patients, families and local authority partners to get appropriate and high-quality care for people with a learning disability as early as possible, investing in community care and avoiding the need for intensive inpatient treatment wherever possible.”

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Lauren Young - Learning Disability Nurse

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