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The issue of restraint in care homes was a news item again recently with the release of the final report into learning disability provision five years on from the shocking revelations of practice at Winterbourne View which has highlighted the practice of restraint and how it can be associated with cruel practice. The report published in February called Time for Change: The Challenge Ahead can be viewed at: https://www.acevo.org.uk
Rules of restraint
The word restraint itself has got connotations of force. ‘We’re not allowed to restrain people’ is something you might hear from health and social care staff. Of course in certain circumstances staff can restrain people, and indeed it may be the safest and best practice to do this when conditions dictate. I’ve come across a very useful short video training package about restraint produced by the Social Care Institute for Excellence (SCIE) which could be a useful resource for a care home . It includes a number of speakers who describe the key elements of restraint.
- First of all it is part of the Mental Capacity Act 2005. Section 6 of the Act allows for restraint if it prevents harm coming to the person, and they lack the capacity to make decisions to keep them from coming to harm. Did you know that Tuesday 15th March is National Mental Capacity Action Day – a government sponsored event to increase awareness of the Mental Capacity Act – a good day to discuss restraint!
- Where someone does have capacity, they may agree to restraint in certain situations, that might seem a strange thing to consent to, but it may make the person be safe or feel safe.
- Restraint isn’t just about one person using their own body to stop someone doing something. The video includes a number of other examples, like restraints on beds, or even the rule book of the home (that might say something about running your own bath).
- Application of restraint should involve the service user in the decision. This is the case with all care planning , and restraint should be seen as part of managing risk which should feature in any whole care management plan.
- There is a human rights context to all of this. Restraint should be proportionate to the harm that might result if the person were not restrained. Of course, if the level, frequency and length of the restraint means that this deprives the person of their liberty, that contravenes their human rights, unless a lawful authorisation has been obtained.
The QCS policy on restraint provides a framework for assessment and management of necessary restraint. Training on current practice is important and the SCIE video would be a useful introduction to the issues. You’ll find the video at http://www.scie.org.uk/socialcaretv/video-player.asp?v=restraint-a-human-rights-issue
David Beckingham – QCS Expert Mental Health Contributor