NSUN network for mental health is an independent, service-user-led charity that connects people with experience of mental health issues to give us a stronger voice in shaping policy and services.

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Restraint must be an absolute last resort

NSUN member Suzie Billingham shares her experience of restraint

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First of all allow me to introduce myself. I am a 37 year old woman with bipolar affective disorder. I was diagnosed 2 years ago during my first inpatient stay and, during a psychotic breakdown, I was sectioned under the Mental Health Act for my own safety and it was during this stay in a London hospital I experienced what can only be described as the worst day of my life.

This particular day I had got it into my head that I was immortal and locked inside the secure unit forever, and that I would never see my children again. I was seen by the doctor and left sobbing my heart out in my room without anyone checking on me.

Later on that afternoon I couldn't take the heartbreak anymore. So, I sat outside the staff office cross-legged and screamed repeatedly for my children. I was surrounded by about 8 members of staff shouting at me to be quiet. To stop it - like a naughty child. I was frightened and just could not stop. Not once did anyone sit down next to me nor ask me what was wrong. There was no de-escalation attempt whatsoever. After several minutes of this I was lifted up (still cross-legged), turned on my side and injected twice.

I remember afterwards the staff just going back to business as usual. There was no debrief. No explanation. I kept saying to various staff members "when is this going to work?" and being completely ignored. I still to this day have no idea what I was injected with.

If this was my experience alone, it could be written off as one instance of bad practice. However, NSUN have recently conducted a survey completed by 65 people of various backgrounds. This shows my experience is not an isolated incident. It indicates that, on many occasions restraint is being used not as last resort as guidelines state it should be, but as standard practice.

The NSUN study (2016) concluded that '52% of respondents stated that their most recent experience of restraint had felt like an act of aggression ‘a great deal’. All respondents from BME communities stated that their experience had felt like an act of aggression ‘a great deal’ or ‘a lot’. Respondents frequently cited the unnecessary use of physical force and the number of staff members who were involved in each incident of restraint'

One respondent said: 'On the ward where I was restrained, threats and use of physical force was a routine part of ward management used as a short-cut to enable staff to get on with their work as soon as possible, with no thought of the impact on the mental wellbeing of patients'

Another element is retraumatisation. Another respondent explains: ' I had previously experienced a lot of violence as a child including being forcibly held down. My experience in the PICU further reinforced my experiences of abuse.'

Alarmingly half of the respondents stated that experiencing physical restraint had affected their engagement with services ‘a great deal’. Only 3 of the 65 participants stated that it had not affected their engagement with services at all.'

One person said 'As a result of repeated restraints during a hospital stay, I developed post-traumatic stress disorder, which has had a profound impact on my health and my interactions with mental health staff. I have been unable to trust mental health staff since and have done anything at all to stop myself doing back into hospital ever again.' 

The worst statistic of all is: '81.13% (n=43) said that there had been no follow up communication or debrief at all.'

It is my opinion that there must be a culture change within mental health services. Restraint MUST be an absolute last resort and that nothing less than 100% of these should have a debrief. 

Lived experience MUST be viewed as expertise on a par with trained professionals. I had experience on the ward of a professional complaining that she was trained and I was not. This is not constructive as those living with mental health conditions day to day are expert in the condition too.

All mental health staff should receive training designed and led by service users with lived experience.

Cultural change is possible as my experience of good practice on the ward shows. I was asked to co-host a meeting alongside a member of staff. All service users were invited to share their experiences - good and bad in an attempt to resolve issues. This is an example of what can work well. If service users and staff can work side by side to create a respectful environment - one aimed at recovery and where service users are treated not as second class citizens, but as experts themselves - the model of mental health would dramatically change. Surely this would be a good thing for professionals and service users alike.

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Blog originally published as part of this midweek ebulletin extra

Image from this article on forced psychiatry

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