The serious case review into abuse at Winterbourne View recommended that supine restraint should be banned, not prone. This has not stopped training organisations who use supine holds campaigning for a ban on prone restraints, which they do not use. Prone has never been banned.
“Guidance provides information and good practice but is not statutory guidance or legally binding. Providers can choose to depart from the Guidance but may be asked (e.g. by court or CQC) to justify their reasons for doing so.”
(NHS Protect consulted DH and HSE; DH provided following clarification “It is accepted that there may be exceptional circumstances where the use of prone restraint will happen…On rare occasions, face down restraint may be the safest option for staff and service users, with few, if any, viable alternatives.” (NHS Protect, March 2015) See article page 3 below: “Care provider prosecuted after death of patient during restraint”.
New guidance from the Department of Health, in the form of a revised Code of Practice for the Mental Health Act 1983, was published in January 2015. This contains some useful clarifications.
The new wording is more careful than that used in the April 2014 document, “Positive and Proactive Care”, avoiding the ‘absolute’ terminology that has created problems so many times in the past. For example, instead of a blanket ban on prone restraint in all circumstances, the wording is now that prone restraint should be avoided unless there is a “cogent reason”. for using it. That phrase should really be applied to all forms of restraint and restriction. Nobody should be using any form of restraint or restriction unless there is a cogent reason for doing so. (Why do anything unless there is a cogent reason?) Thanks to Bernard Allen (March 2015)
The legal and ethical basis for services to permit their staff to use restrictive interventions as a last resort is built upon on eight fundamental principles.
1: Restrictive interventions should never be used to punish or for the sole intention of inflicting pain, suffering or humiliation.
2: There must be a real possibility of harm to the child or to staff, the public or others if no action is undertaken.
3: The nature of techniques used to restrict must be proportionate to the risk of harm and the seriousness of that harm.
4: Any action taken to restrict a child’s freedom of movement must be the least restrictive option that will meet the need.
5: Any restriction should be imposed for no longer than absolutely necessary.
6: What is done to children and young people, why and with what consequences must be subject to audit and monitoring and must be open and transparent.
7: Restrictive interventions should only ever be used as a last resort.
8: When reviewing plans for restrictive interventions it is essential to involve, children and young people, their families, and advocates, as appropriate.