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Increasing rise in the use of restraint in NHS Hospitals

Defining restraint ‘Anything which interferes with, or stops, a service user doing what they appear to want to do’ (Clarke and Bright, 2002). The Mental Capacity Act 2005 UK Section 6 defines restraint as the use or threat of force where an incapacitated person resists, and any restriction of liberty or movement whether or not the person resists. Restraint is only permitted if the person using it reasonably believes it is necessary to prevent harm to the incapacitated person, and if the restraint used is proportionate to the likelihood and seriousness of the harm. Staff must be clear about when they are using restraint and should refer to: The legal definition from the Mental Capacity Act 2005 UK, states that someone is using restraint if they:

  1. Use force – or threaten to use force – to make someone do something they are resisting, or

  2. Restrict a person’s freedom of movement, whether they are resisting or not.

Service users with lost capacity Of those service users who present challenging behaviour, by far the largest group are adult service users who have lost their capacity.  Because they are incapacitated, such people must be treated in their best interests. Staff must continue to manage the situation that is presented to them. Interventions are inherently unpleasant to the service user, almost always involving the person being touched, in circumstances where the service users’ objections will be overruled, albeit politely. It is little wonder that such perplexed, frightened or irritated service users sometimes need to be restrained if they are to be treated in their best interests. Irrespective of their lack of capacity, (and perhaps particularly importantly because of it), staff will strive to be invariably polite to the service user whose consent to the potentially unwanted touch is waived in this way. Nevertheless, staff may be required to restrain service users in their best interests; ensuring that the restraint used is proportionate to the degree of resistance that the patient employs to avoid the administration of the treatment. In addition, the form of restraint must be the least restrictive option available to achieve the desired result. The legal authority for this approach comes from the Mental Capacity Act 2005 (MCA). The aim of restraint in an incapacitated adult is to ensure that the service user remains unharmed by their own actions; and that the staff looking after them, and bystanders, are also protected from harm.

Preventing the use of restraint The Department of Health and Skills for Care have produced a set of principles and guidance that should be adopted by services:

  1. Compliance with the European Convention on Human Rights at all times.

  2. Gain an understanding of people’s behaviour that allows us to see their unique needs, hopes, experiences and strengths and to help them improve their quality of life.

  3. It’s essential to involve people with care and support needs and their families, carers and advocates, wherever practicable, if the person wishes.

  4. People must be treated with compassion, dignity and kindness.

  5. Social care and health services must support people to balance safety from harm with freedom of choice.

  6. We must protect positive relationships between the people who deliver services and the people they support.

Restrictive practices Means anything that stops someone doing something, or that makes them do something. It can be for example:

  1. Holding someone down or holding part of their body (physical restraint), or

  2. Using medication to make someone calm (chemical restraint), or

  3. Taking things away from them that they need, like a walking frame or money or a key, or

  4. Only allowing someone a safe amount of a food that they might eat too much of

  5. Fastening someone in a wheelchair or bed or in a room or isolating them on their own.

Summary Stephen Adams report draws our attention to the growing use of restraint in NHS Hospitals. There are no figures available for social care services, although they will be faced by service users who present challenging behaviour. Research continues to show that physical restraints are not safe and do not decrease the risk of injury. These methods can be extremely harmful to service users and can increase both physical and emotional suffering. Care services should view restraint as a last resort and only in agreement with the services user’s representatives and in their best interests. Bettal Quality Consultancy have produced policies and procedures based on best practice when considering the use of restraint which are available to readers at: Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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