In November I was privileged to chair a conference in London about child to parent violence in adoptive and foster families. The day had been crafted to follow a narrative as we explored the effects of trauma for the child and then for the whole family; different insights into law and practice; and finally a session on how to respond when things really kick off. This came in part as a response to discussions I and others had been having about the training available for families in how to keep children safe. I know that some people had found this difficult or impossible to access, and so we were pleased to be joined by Lee Hollins of Securicare and Amanda Boorman of the Open Nest, who, between them, have done much to open up this topic and provide some answers. Following on from the conference, Lee has written 2 guest blogs for us, the first here and the second to follow in a week or so.
We Need To Talk About Restraint – Lee Hollins
Restraint. It’s word that conjures up many images in the minds of many people. Mostly bad, and often in the minds of practitioners working in the field of fostering and adoption. That’s why we need to talk about it. The recent ‘Child to Parent Violence in adoptive and foster families’ conference chaired by Helen was just such an opportunity.
As a guest speaker I started by offering a definition. The Mental Capacity Act 2005 defines ‘restraint’ as when someone “uses, or threatens to use force to secure the doing of an act which the person resists, or restricts a person’s liberty whether or not they are resisting”. To me this speaks of control and coercion; of overriding people’s minds and overwhelming their bodies.
Sadly the use of restraint to control and coerce is nothing new. It was a central feature of the Asylum movement in the 1800’s, with psychiatric patients being subject to the use of force by often very physical male attendants. A former ‘inmate’ at Stafford Asylum described the regime there, “No thought can conceive, no tongue can tell, no pen can describe the manifold horrors, the atrocious cruelty, the fraud, the guile, the imposture that pervaded every part of that lauded asylum. . . .” (Smith, 1988)
For many in the modern era the embodiment of Physical Restraint was the ‘Control and Restraint’ system that operated across the prison service estate in the 1980’s (Wright 1999). It was derived from various Martial Arts including Aikido and Jiu-Jitsu (Tarbuck, 1992). It included many powerful techniques, such as pain compliance, takedowns and holding individuals face down on the floor (the forced prone restraint position). Restraint was often implemented by 5-person teams specifically trained to dominate unruly prisoners. In time the overuse, misuse and abuse of these techniques led to injuries and deaths, and scandals that revealed the punitive use of techniques (Amnesty International, 2001). Things needed to change.
In the early 1990’s the community care reforms led to markets opening up which supported the provision of therapeutic health and social care environments. It proved to be the perfect time to redefine and rebrand ‘restraint’. The term that came into common usage was ‘physical interventions‘. This referred to “any method of responding to challenging behaviour which involves some degree of direct physical force to limit or restrict movement or mobility” (Harris et al, 2008). Key to meeting the needs of the market, and in particular serving the best interests of service users, was the jettisoning of the coercive and harmful elements of the earlier C&R system. No more five person teams, no more takedowns, no more pain compliance and no more prone restraint.
SecuriCare has operated in the health and social care sector for over 20 years, and has been in the vanguard of developing person-centred, trauma informed and sensitive behavioural management strategies. The good news is that the evolution of holding strategies has continued apace. In my next blog we will examine the most up-to-date ‘safe holding’ and ‘therapeutic holding’ practices.
Lee Hollins, PGCert Health Research, BSc (Hons) Physiotherapy
E: firstname.lastname@example.org M: 07760788712 W: http://www.securicare.com
Amnesty International (2001) Public statement on Wormwood Scrubs. https://www.amnesty.org.uk/press-releases/united-kingdom-public-statement-wormwood-scrubs.
Department of Health (2015) Mental Health Act 1983: Code of Practice. London: The Stationary Office.
Duxbury, J. and Paterson, B. (2005) The Use of Physical Restraint in Mental Health Nursing: An examination of principles, practice and implications for training, Journal of Adult Protection, 7 (4) pp. 13-24.
Harris, J., Cornick, M., Jefferson, A. and Mills, R. (2008) Physical Interventions. A Policy Framework. Revised Edition. Kidderminster: BILD/ NAS.
Smith, L.D. (1988) Behind Closed Doors; Lunatic Asylum Keepers, 1800–60, Social History of Medicine, 1 (3) 1: pp. 301–327.
Tarbuck P. (1992) Use and abuse of control and restraint. Nursing Standard, 6, pp.30–32.
Tucker, R. (2003) Good practice in the management of violence, Paper presented at the Therapeutic Management of Aggression and Violence Conference, Royal Scottish National Hospital, Larbert.
Wright, S. (1999) Physical restraint in the management of violence and aggression in inpatient settings: a review of issues, Journal of Mental Health, 8 (5) pp.459-472.