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Last Updated: Tuesday, 22 February, 2005, 23:50 GMT
Rules issued on patient restraint
David 'Rocky' Bennett
David Bennett was restrained for 25 minutes before he died
Physically restraining violent mental health patients should be a last resort and measures must be taken to protect the aggressor, guidance says.

But the National Institute for Clinical Excellence (NICE) stopped short of setting a maximum time psychiatric patients should be restrained.

The guidance was issued following the death of David "Rocky" Bennett who died after being restrained at a clinic.

NICE said the advice would help safeguard NHS staff and patients.

The guidance said restraint or tranquillisation should only be considered once all other calming methods had failed.

If a patient did need restraining, their head and neck should be supported by one member of the NHS team, NICE said.

Key NICE guidance
Physical restraint should be the last resort
Patients head and neck should be supported during restraint
NHS staff who deal with potentially violent patients should have training to recognise signs
Mental health service providers to produce risk management strategies

Staff dealing with potentially violent mental health patients in hospitals should be trained to recognise anger and other risk factors as well as how to protect the patient from harm.

But the NICE proposals did not include one of the key recommendations put forward by the inquiry into the death of Mr Bennett.

The 38-year-old collapsed in 1998 after he was held face down for 25 minutes after hitting another patient - who went on to attack and racially abuse him - and punching a female nurse.

Inquiry head Sir John Blofeld recommended last year that no patient should be held in a prone position for more than three minutes.

But NICE said it was impossible to put a maximum time limit on restraint.

Chief executive Andrew Dillon added: "Managing violent behaviour is about more than drugs and restraint."

Training to identify and deal effectively with violent behaviour without resorting to drugs or physical restrain will only work if there is a major increase in the number of nurses
Marjorie Wallace,

He said the guidelines, which will be used by the Healthcare Commission in its inspections, will help to safeguard patients in both mental health settings and accident and emergency departments.

Ian Hulatt, of the Royal College of Nursing, agreed it was not practical to put a limit on the length of restraint.

But he added: "I think these guidelines will serve both patients and NHS staff well."

But Mr Bennett's sister Joanna said: "I'm extremely disappointed. They haven't adequately addressed the issues that have been raised.

Dr Bennett said she was particularly upset that no time limit had been imposed on the amount of time someone could be restrained.

Mental health charity Sane chief executive, Marjorie Wallace, said the NICE advice was "a sensible way forward".

"However, training to identify and deal effectively with violent behaviour without resorting to drugs or physical restrain will only work if there is a major increase in the number of nurses and improvement in the state of psychiatric wards.

"While these shortages and conditions remain, it will be difficult for nurses to sustain relationships and respond to early signs of disturbed or violent behaviour."

And Mind chief executive Richard Brook said: "We are dismayed that the guidelines do not specify a maximum time limit for physical restraint.

"Failure to introduce a maximum time limit for restraint seriously threatens the well-being of some of the most vulnerable people in the mental health system."

Public inquiry into clinic death
06 Mar 03 |  England

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