Controversial face-down restraints are still used on mental health patients in England

Mental health patients are pinned face down by staff thousands of times a year, despite ministers and health experts repeatedly warning this is dangerous.

Prone positioning, which involves holding a person chest down to defuse an incident, has been a source of controversy for years and has been implicated in the deaths of a number of people with mental health problems.

In 2014, the then coalition government responded to widespread concerns about its use by acknowledging that it ‘may result in dangerous compression of the chest and airways and endanger the person being held” and told mental health units in England to phase this out.

But new NHS figures obtained by the Liberal Democrats show that face-down restraints were used 5,247 times in 2023 alone, and 3,732 times in the first ten months of this year. “These findings are alarming,” said MP Danny Chambers, the party’s mental health spokesperson.

The National Institute for Health and Care Excellence (Nice) and the Care Quality Commission, the NHS’s healthcare regulator, advise mental health providers to avoid the use of prone positioning and, if they do, to do so for as short a time as possible .

And government guidelines of 2021 are clear that “there shall be no planned or intentional restraint of a person in the prone or prone position on any surface, not only the floor.”

Holding someone face down is one of many different forms of manual or chemical restraint used by mental health hospital staff when an admitted patient becomes disruptive, aggressive or violent. They may also restrain, handcuff, or sedate the person.

The Mental Health Units (Use of Force) Act 2018 was intended to prevent the “disproportionate and inappropriate” use of any form of force to protect the dignity and respect of patients. It was also called “Seni’s law” because it was inspired by it the death of Olaseni Lewisa black man who died in 2010 after being restrained by police officers while suffering from a mental health crisis while being treated in an inpatient unit in London. The then Conservative government delayed the introduction of the legislation for three years.

Freedom of information responses to the Lib Dems from 30 of England’s 54 NHS mental health trusts show that the use of any form of restraint is still widespread. A total of 16,186 patients were detained in 2022, 16,920 in 2023 and 14,642 in the first ten months of this year.

These trusts recorded 900 cases of a patient being injured as a result of restraining in 2023 and a further 702 between January and October this year. Personnel were injured 2,278 times while applying restraint in 2022 and 1,885 times in the first ten months of this year.

Some trusts appear to make much more use of restraint, and in particular face-down restraint, than others. For example, the East London Mental Health Trust used some form of restraint 3,831 times in the period January to October – the most in England – while the comparable body in Cambridgeshire and Peterborough did this 147 times.

Similarly, Cumbria, Northumberland, Tyne and Wear Trust used face-down coercion 495 times between January and October, while Cornwall Partnership did so just four times.

“Physical restraint can cause significant stress to vulnerable patients and leave staff with serious injuries. “That some institutions physically restrain mental health patients far more than others shows that our NHS services have been neglected and overlooked for too long,” Chambers said.

It is “particularly worrying” to see such persistent use of restraint, despite Seni’s law finally being implemented three years ago, he added. He urged ministers to launch an investigation into the situation, which has arisen because the last Tory government failed to improve mental health care and “some of the most vulnerable people in our society are now paying the price”.

Andy Bell, the chief executive of the Center for Mental Health think tank, said: “It is deeply worrying that restraint is so often used in mental health care, despite legislation to reduce the use of force and ongoing efforts to improve quality.

“Inpatient services are under enormous pressure, with occupancy levels in some wards above safe levels, chronic staff shortages and outdated facilities making it more difficult to provide good care.” Alternatives to mental health hospital stays are urgently needed, he added.

Mind, the mental health charity, said: “Healthcare workers do challenging work and must intervene if someone poses a risk to themselves or others. However, Restriction should only be used as a last resortwhile prevention and de-escalation have not worked.”

A spokesperson for the Department of Health and Social Care said: “This data is incredibly worrying. Patient safety is of the utmost importance, and anyone treated in an inpatient mental health facility deserves safe, quality care and should be treated with dignity and respect, with face-down restraint used only as a last resort.

“Our Mental Health Bill will ensure that people with the most serious mental health problems receive better, more personalized treatment that is appropriate, proportionate and compassionate to their needs.

“We will also work with the NHS to transform care and recruit an additional 8,500 mental health workers across child and adult care to reduce delays and provide faster care.”