Controversial 'face down restraint' used in Northern Ireland's mental health facilities



“Their head is supported at all times to ensure airways and breathing is not compromised” – HSCB

By Kathryn Torney

THE Health and Social Care Board has defended the use of ‘face down restraint’ by staff working in Northern Ireland’s mental health facilities.

Last month, mental health charity Mind called for NHS England to put an end to “life-threatening face down restraint” of people with mental health problems in healthcare settings.

Data obtained by Mind under the Freedom of Information Act revealed that at least 3,439 patients in England were restrained in a face down position in 2011-12, despite what the charity described as the increased risk of death from this kind of restraint.

Half of all face down restraint incidents recorded in England occurred in just two trusts: Northumberland, Tyne and Wear NHS Foundation Trust and Southern Health NHS Foundation Trust.

Two others – Hertfordshire Partnership University NHS Foundation Trust and Sheffield Health and Social Care NHS Foundation Trust – have already put an end to using face down restraint altogether.


We asked the HSCB if face down restraint was used in Northern Ireland’s mental health facilities and, if so, was a record kept of these incidents. We also asked how many incidents have been recorded and over what time period and also if any fatalities had been recorded following the use of this technique in Northern Ireland.

It took the HSCB almost two weeks to respond to our query.

The board confirmed that patients are restrained in a prone position (face down) in Northern Ireland but added that this should only take place as “a last resort”.

In response, a leading local mental health charity told The Detail that it “does not believe that face down restraint has a place in 21st century mental health care” and it called for further investigation into its use in Northern Ireland.

The HSCB spokeswoman stressed that patients are not restrained in a position where their face is down on either a bed or floor.

And: “Where a patient is restrained in a prone position on their front their head is supported by a member of staff at all times to ensure airways and breathing is not compromised.

“Physical restraint would be applied through holding the patient’s arms and legs ie. main limbs only.

“This restraint is classified as prone physical intervention and the head is always controlled and supported. This is in line with NICE clinical guidelines.”

She added that the board does not hold statistics on the use of physical interventions.

She continued: “Trusts record all incidents on the incident recording system and on the clients’ records but (it) would require a manual search to identify the exact numbers.”

There is no record of any fatalities involving restraint in trust mental health facilities in Northern Ireland.

The HSCB statement also said: “The board welcomes the recent report published by Mind which highlights the concerns widely shared about physical interventions, and the position from the Royal College of Nursing who recently voted unanimously to establish an accreditation and regulation framework for physical intervention training in NHS mental health settings.

“We remain committed to restraint reduction and believe any form of restraint (physical, chemical, environmental, social or mechanical) should be avoided unless as an absolute last resort when individuals endanger themselves or others.

“Physical intervention in a face down position is included within the Management of Actual or Potential Aggression (MAPA) programme.

“In trusts, staff members are trained within the MAPA philosophy of reducing risk and ensuring care, welfare, safety and security for all concerned.

“The skills used are British Institute of Learning Disabilities accredited who scrutinise all techniques and accept their use as part of the risk management strategy but only ever used as a last resort.

“The training model (MAPA) has been delivered to a wide range of staff in a variety of settings since 1992, and aims to ensure that everyone involved in crisis situations which include disruptive, challenging, or violent behaviour can maintain the care, welfare, safety and security of all involved.

“The physical interventions taught within the programme have been independently risk assessed, are compliant with the UK national Physical Interventions Accreditation scheme (PIAS).

“Where physical restraint is required it is a last resort and the safety of the patient whilst being restrained is paramount."

The full HSCB response to our questions is available below this article.

We asked local mental health charity MindWise to comment on the use of face down restraint in Northern Ireland. Mindwise supports people affected by severe mental illness and other mental health difficulties and promotes early intervention.

A spokesperson for the charity said: “MindWise welcomes and supports Mind’s recent call to end ‘life threatening’ face down restraint of people with mental health problems in healthcare settings in England.

“The extent of this practice is unclear in Northern Ireland which is a further worry. This should be investigated to determine the extent and impact on individual’s mental health and wellbeing.

“MindWise do not believe that face down restraint has a place in 21st century mental health care.

“While we appreciate that staff often manage particularly difficult situations, a pro-active approach to early invention through Wellness Recovery Action Planning (WRAP) inclusive of crisis planning should be instilled in practice across the sector.”


Mind reported that there were at least 39,883 recorded incidents of all kinds of physical restraint in England during the 12 month period, resulting in at least 949 injuries to people with mental health problems.

Paul Farmer, chief executive of Mind, said: “Physical restraint can be humiliating, dangerous and even life-threatening and the huge variation in its use indicates that some trusts are using it too quickly.

“Face down restraint, when a person is pinned face-down on the floor, is particularly dangerous, as well as extremely frightening to the person being restrained. It has no place in modern healthcare and its use must be ended.

“Our research shows that some trusts have a shameful over-reliance on physical restraint and use face down physical restraint too readily in their response to managing a crisis situation.

“We know that healthcare staff do a challenging job and sometimes need to make difficult decisions very quickly, but physical restraint should only be used as the last resort, when there’s no other way of stopping someone from doing themselves or others immediate harm. There is never an excuse for face down restraint.”

Sinn Fein Assembly member Sue Ramsey is chair of Stormont’s All Party Group on mental health.

She said: "I welcome the concerns highlighted by Mind about physical interventions and I also welcome the position from the RCN to establish a framework for physical intervention.

“My information is that physical restraint is used as a last resort but at all times the safety of the patient is paramount and that patients’ heads are supported so their faces are not down on beds or floors and this is to be welcomed.

“Any concerns that groups and organisations raise are useful and the department needs to take these on board when developing strategies.”

© The Detail 2013

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