The heads of two learning disability charities have called for urgent change in the Mental Health Act regime after a report highlighted evidence of restraint and seclusion being used in learning disability units.
The Care Quality Commission’s (CQC) fourth annual Mental Health Act report highlighted evidence of patients’ experiences of being restrained in wards – including learning disability wards – despite its Code of Practice emphasising that physical restraint is a last resort in the management and containment of conflict.
In 2013, a report by mental health charity Mind found that prone or face-down restraint – defined as ‘pinning and holding someone face down on the floor for a period of time’ – had been used more than 3,000 times in NHS mental health trusts in 2011/12.
The CQC emphasised in its report that, in compliance with their registration under the Health and Social Care Act, all providers must make sure staff are trained and competent in de-escalation and restraint techniques.
In addition, the CQC said it is working with the Department of Health, NHS England and other organisations to support the development of national guidance on positive behaviour interventions and the use of restraint.
Urgent change call
But the “shocking” examples of restraint in the CQC’s report show that change is needed to ensure that these practices are kept to a minimum, according to Jan Tregelles (pictured), chief executive of Mencap and Vivien Cooper, chief executive of The Challenging Behaviour Foundation.
In a joint statement they said: “It is clear from the CQC report that urgent change is needed to ensure people detained or treated under the MHA get the least restrictive care possible, and that the use of restraint and seclusion is kept to a minimum. We are deeply worried that despite this being required by the law, it is not happening in practice.
“The report contains some shocking examples of the use of restraint and seclusion in units for people with a learning disability. Two and a half years after the scandal at Winterbourne View, where people with a learning disability were victims of abuse and inappropriate use of restraint, it is unacceptable that not enough has changed.
“We welcome the CQC’s commitment to making sure everyone detained under the MHA is supported using person centred approaches and cared for in the least restrictive way possible. To make this a reality for people with a learning disability, commissioners, providers, health and social care professionals and the CQC will need to focus on the specific needs of this particularly vulnerable group of people who often can’t speak up for themselves.
“People with a learning disability who display behaviour that challenges must be treated with dignity and respect and their needs understood. It is crucial that the support they receive is underpinned by the principles of positive behaviour support and that barriers to accessing independent advocacy and legal representation are removed.”