What is restraint? An array of interventions, some of which are coercive, the merits of which may not be known. The ways in which restraint is perceived differs markedly – with many professionals broadly asserting its necessity – typically by citing extreme examples – and people with learning disabilities and autism and their families questioning its necessity.
Which principles should underlie physical intervention? The following elements of principles should underlie physical intervention:
• The context should be known i.e. there are risky environments, risky management decisions, risky managers and practitioners and risky practices. The latter would include, for example, undertaking a physical intervention without any knowledge of a person’s biography.
• The traumas people are known to have endured should not be reinforced by any form of a physical intervention e.g. people who are known to have been sexually assaulted should not be placed on the ground and immobilised by body weight
• People’s experiences of being subject to restraint, for example, should be known – are they doing to their peers and staff what they have endured in previous settings?
• Individuals should never be restrained when they are naked or partially naked. Furthermore, when naked or partially naked, they should never be immobilised by body weight
• Any intervention has to be part of an agreed and positive approach
• Chemical restraint, physical restraint, mechanical restraint and/or seclusion should not co-occur
What data is required? Every incident of physical restraint should be recorded as a patient safety incident. What is the point of counting incidents if nothing other than the fact of a physical restraint, for example, is known? Information concerning physical interventions requires a single route.
How we get from where we are now to where we want to be? The NHS Commissioning Board should issue a series of edicts, i.e. Thou shalt…
• Adopt a life-span approach to people with learning disabilities and autism, referencing this in their service specifications
• Put a moratorium on building new secure services or extending such services in the knowledge that if there is a building it will be filled
• Ensure that the Care Quality Commission does not register units which are outwith national policy i.e. Assessment and Treatment units
• Review and challenge the use of the mental health legislation as it impacts on adults with learning disabilities and autism on a locality basis
• Discontinue the office function of long distance commissioning in favour of investing in effective and credible local supports - if Winterbourne View Hospital patients and their families had known the telephone contact details of individual commissioners – it is unlikely that they would have had to resort to calling the police
• Promote the piloting of micro-commissioning – with people with learning disabilities and autism, their families and their local authorities
• Only invest public money and commission services from agencies which are owned by accountable individuals i.e. not opaque corporate bodies
• Ensure that a service’s Statement of Purpose cites “positive behaviour support” and that this is reviewed by the Care Quality Commission
• Cease to believe that (i) compliance with minimum standards results in a safe and valued support service which requires neither monitoring nor evaluation and (ii) that professionals know everything
Margaret Flynn, contributor and note taker,