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Elmbank Mill, The Charrier
The high levels of restraint use reported in NHS intellectual disability services should be a source of concern.
Such services support a number of individuals with a range of complex needs whose distress may present as behaviour that challenges. On occasion, restraint may sometimes represent the least restrictive intervention, but what these statistics don’t tell us is that they are.
We don’t know whether the evidence based and values led person centred support, based on a holistic functional assessment that incorporates the assessment of potential trauma, reflecting an awareness of the significance of attachment is in place.
We don’t know whether the staff providing support have access to regular clinical supervision, to deal with the toxic emotions arising from exposure to distress presenting as behaviour that challenges.
We don’t know whether debriefs are routinely being carried out following restraint.
We don’t know whether individual services have active restraint reduction strategies and are consciously developing emotionally intelligent practices driven by a desire to improve the well-being of staff and patients.
Because there is so much we don’t know we should worry because what the literature on corrupted cultures says is such interventions are prone to misuse. Our job as practitioners and our responsibility as a society is to prevent this and ensure such interventions truly are used only as a last resort.
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