Guidelines Set No Time Limits For Face-Down Restraints
By Dave Reynolds, Inclusion Daily Express
February 25, 2005
LONDON, ENGLAND--Guidelines published this week over the use of physical restraints in mental health facilities and detention centers are facing criticism for not setting a time limit on "prone restraints" -- those where the patient is held face-down on the floor or ground.
The National Institute for Clinical Excellence issued its guidelines on Wednesday, calling for the National Health Service in Wales and England to, among other things, use chemical restraints (tranquilizers), physical restraint and seclusion only as a last resort and as a "reasonable and proportionate response to the risk posed by the service user"; to train staff on de-escalation and other techniques to prevent violent behaviors; and to have a staff member to support the person's head and neck, and to monitor the person's breathing.
However, the guidelines did not set a limit on the amount of time a person could be restrained face-down, as had been recommended by a government inquiry. That inquiry had been prompted by the October 1998 death of David "Rocky" Bennett. The 38-year-old Jamaican-born musician died while a mental health patient at Norvic Clinic in Norwich.
On the night of his death, Bennett was removed from his ward after fighting with another patient who had "racially" abused him. While resisting the move, Bennett assaulted a nurse. Five nurses then used "control and restraint" measures, holding Bennett face down while immobilizing his arms, ankles and upper chest for 28 minutes. After some time, the nurses realized that he was no longer struggling -- or breathing. They were not able to revive him.
He was pronounced dead a short time later.
Nobody was prosecuted for Bennett's death. Most of the nurses involved in the fatal restraint have returned to work at the same clinic.
The official inquiry into Bennett's death had recommended a three-minute time limit for prone restraints.
Sue Johnston, a psychiatrist and member of the group which developed the new guidelines, told the Guardian that it was dangerous to assume that three minutes was "magically safe".
"There is no safe time. Any intervention is potentially hazardous," she said.
"Rules issued on patient restraint" (BBC News)
"NICE issues guidance on the short-term management of disturbed/violent behaviour" (National Institute for Clinical Excellence)