Prone restraint in mental health hospital

My partner and I recently finished Season 4 of Orange is the New Black (highly recommend), and one episode particularly resonated with me. In fact, it made me cry, and I’m not a crier.

The episode centred around an inmate named Poussey, who, in the midst of an ‘incident’ within the prison, was forcibly held to the ground by a prison guard for an extended period of time, whilst the prison guard was being tackled by another inmate.

My partner had no idea what the result of this act would be. I knew, through my work within Public Law and mental health, and I knew that the use of such restraint can bring about death.

Prone restraint is where a person is held to the ground in a face-down position and is physically prevented from moving from that position. Too much force and the result can be fatal. The concern is that prone restraint can result in dangerous compression of the chest and airways, thus placing the person being restrained at a huge risk.

The majority of NHS Trust policies on the use of such restraint suggest that it ought to be used only as a last result, following unsuccessful attempts at de-escalation. Unfortunately, I am aware of incidents where prone restraint appears to be used as a first port of call, often on those with severe learning disability, and often in mental health hospital.

I appreciate that professionals within such a setting must keep themselves, the service user and other patients’ safe, but it is frightening that use of prone restraint remains commonplace, and remains the norm, despite policy suggesting that it should be used only in the most extreme circumstances.

There is a reason that prone restraint ought to be used as a final option – in 1998, a 38 year old gentleman named David Bennett was held in the prone restraint position by 5 staff members for a 25 minute period, resulting in his death. An independent inquiry (bbc article 18/06/13) found that Mr Bennett died as a direct result of prolonged face-down restraint and the amount of forced used by staff.

Did this end the use of prone restraint? No. According to Mind (2013), there have been 13 reported incidents of restraint related deaths in the UK since this. This figure is only for those detained under the MHA 1983 and included only those deaths which were actually reported. The figure is therefore likely to be higher, particularly taking into account the years following the study.

Shockingly, as someone living and working in the North East of England, Northumberland Tyne and Wear NHS Foundation Trust responded to a freedom of information request from Mind and stated that, in 2011-2012, prone restraint was used 923 times.

This is not uncommon, however, with Stewart et al (2009) finding that manual restraint is used 5 times per month on an average mental health ward. According to Mind, one Trust which responded to an FOI request stated there had been 38 incidents of prone restraint, whilst another said there had been over 3000 incidents.

Mind’s recommendation from the 2013 research was, of course, that the government ought to end the use of face down physical restraint.

Has this happened? Of course it hasn’t. The figures speak for themselves. Prone restraint continues to be used, on a large scale, and for as long as this is the case, there will be more and more restraint related deaths.

Not only ought the risk of death be enough for professionals to use every possible de-escalation technique available, but the use of such restraint can cause physical injury and psychological harm. Mind (2013) provided a quote from someone who had experienced such restraint; “it made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better”.

The free reign to use prone restraint is frightening. The fact that it is used to varying amounts across the country is worse, because it suggests either that instances of prone restraint often aren’t reported, or that staff aren’t provided with the same training across the board. I fear that both are correct.

Those detained under the MHA 1983 are in hospital, usually, for assessment and/or treatment. The mental health hospital ought to be viewed as a place of safety, where care is provided to those in crisis. The possibility of attending hospital and dying there due to an excessive use of force by those who were supposed to be caring for you, is a frightening concept, but it is one that is all too real.

Patients need to feel safe in the hospital environment. The use of prone restraint must be ended.

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Depression and Parkinson’s Disease

Today’s headline reads ‘Depression may be factor in Parkinson’s risk’. This comes from a Swedish study where more than 500,000 people were tracked for over two decades.

The finding was that people with depression may be almost three times more likely to develop Parkinson’s disease.

Parkinson’s Disease is something very close to my heart – my grandfather was diagnosed with Parkinson’s Disease rather late, as doctors thought that his troubles may be caused by a past heart operation, leading them down the wrong path. Diagnosis took a while and the disease took hold of my Grandad pretty quickly. I was 16 years old when he passed away, and in the end he was bedbound, unable to swallow, blink or talk. It was awful to see, particularly given that only 5 years prior to that he was dragging me round in a sledge at the age of 76 when I was quite clearly too heavy.

Often, people associate Parkinson’s Disease with shaking, but my Grandad never really had that and, though people say that you cannot die from Parkinson’s Disease, that is what went down on my Grandad’s death certificate.

Because of my experience with Parkinson’s, I really want to make whatever difference that I can. Parkinson’s UK is not government funded and therefore relies entirely on donations from the public. Two weeks ago, myself and my partner walked 6 miles for Parkinson’s UK and raised just under £350 in the process. It really isn’t a huge amount but the charity was very grateful.

parkinsons

The problem with Parkinson’s is that there isn’t enough money available to fund research into the disease. In truth, people don’t seem to view Parkinson’s as one of the ‘big’ diseases (for want of a better phrase) and therefore know very little about it.

Parkinson’s is a neurodegenerative disease, affecting around 127,000 people in the UK (or one in every 500). It is the second most common neurodegenerative disease after Alzheimer’s and it is a condition which causes loss of nerve cells in the brain. The disease is categorised by shaking, slowness of movement and stiffness.

This study has now linked Parkinson’s and depression, though it is not certain as to whether depression is a “very early symptom” of Parkinson’s, or whether depression is a risk factor which increases the chances of developing the disease.

140,000 Swedish citizens over the age of 50, who had been diagnosed with depression between 1987 and 2012, were studied. Each person was matched with three control participants i.e. someone who had not been diagnosed with depression and who had the same year of birth and sex as the person with depression. It was discovered that 1.1% of those with depressive symptoms developed Parkinson’s. In comparison, the figure for those who did not suffer depression was 0.4%.

Interestingly, no link was found between Parkinson’s, depression and genetic or environmental factors – there was no link between one sibling having depression and the other having Parkinson’s. Crucially, when the researched adjusted for other conditions related to depression such as alcohol and drug abuse, the link between depression and Parkinson’s did not change.

The more serious the depression, the greater the risk of Parkinson’s disease. People who had been hospitalised for depression were 3.5 times more likely to develop Parkinson’s disease than people who had been treated for depression as outpatients.

This new study could really have an impact on our understanding of Parkinson’s Disease and our understanding of depression. My hope is that the articles on this study in newspapers today will raise awareness of both issues, and will encourage earlier, more accurate diagnosis in sufferers. Every single hour, someone in the UK is told that they have Parkinson’s Disease, and we need to work together to find a cause and ensure that people are able to live a long, happy life with Parkinson’s Disease.