MET Police Response to Psychiatric Units

I have said before that restraint is very often shrouded in misinformation, misinterpretation, and grey areas and is an especially emotive subject when it involves children. This can easily lead to decision makers making incorrect, and even dangerous choices when creating well intended provisions for the safety of pupils and staff. But this is not an isolated reason why we have seen unprecedented attention within the media reflecting a growing concern about restraint in schools. Mismanagement is generally a result of systematic failings as opposed to finding a single cause. Recently, the Equality and Human Rights Commission announced they would be launching an inquiry into schools’ use of restraint on pupils . Now, please excuse the sub-title of this piece, but I truly hope the investigation is thorough and shines a massive light on the realities of restraint in schools not only for the pupil but also to reflect the physical and emotional cost for both teachers and senior managers. A Reactive Culture There seems to be a reactive culture when addressing restraint in schools. It is often the case that management will only acknowledge the requirement of positive handling training after they are faced with violence. But by this point, the damage is already done. The child is mismanaged, and staff are put in the untenable situation of not being fully equipped to manage the situation safely. In short, everyone’s physical and emotional well-being are being put at risk. Towards a Proactive Culture But would it not be better to proactively prevent these incidents in the first place? It is very rare that an individual child will demonstrate behaviour that has made restraint necessary without warning and danger signs. Additionally, the vast majority of children who have been restrained within schools have been restrained on a number of occasions, and if recorded properly, these incidents will usually have a common pattern of behaviour and distinct triggers. If we are aware that a child is a risk to themselves or others, we have a legal obligation to carry out a risk assessment (yes, I’m banging that drum again) that should be carried out specific to that individual child. Why is this important? Central to all restraint policies should be ways to reduce the incidents of restraint and so maximise the safety of pupils and staff. How do we do that? We reduce the need for restraint by recognising common patterns in behaviour, or changes in a child’s environment that we know is likely to cause a downward turn in that child’s conduct. This information can feed into a Positive Behaviour Support plan, thus aiding us in proactively managing a child and their experiences. Furthermore, there is actually a legal requirement for schools to have adequate reporting procedures in place should any level of force be used against a child. How do we know what these triggers are? We are in a better position to understand challenging behaviour when we can unpack the circumstances in which it arose, but we can only do that with accurate reporting of incidents and information sharing. We might ask ourselves the following questions; What was the build up to this incident? What happened? Where did it happen? When did it happen? What did you do? Why did you take that course of action? This helps build a picture of the entire incident through the eyes of the staff member in question. Legally speaking, this is exactly how a person’s actions are judged. By collating a number of reports, it becomes easier to identify patterns in behaviour, environmental impact on the child at each incident, if a specific individual is the cause for certain types of behaviour and so on. The need for information sharing The sharing of positive behaviour support plans and risk assessments is vital to ensure the safety of the pupil and others that may work with that pupil on a day to day basis. If we keep the information recorded but locked in a filing cabinet, we might just as well have not done the risk assessment in the first place because the frontline staff are not aware of it. A teacher I had a discussion with recently had been assaulted by pupil that had been transferred from another school and had a risk assessment and care plan specific to him. Unfortunately, the teacher in question had not been made aware of the care plan or risk assessment relating to the child, so she treated him as she would every other child in her class. Once the incident with the child had been resolved and the related investigation had begun, only then did she find out about the care plan and risk assessment. When she asked why she had not been told about these documents, she was told it was for “data protection purposes”. Had she been privy to this information, she would have probably managed the incident as per the care plan had she known about it. How could she be expected to follow the preferred methods enshrined in the document if she wasn’t made aware of them? It stands to reason the assault on the teacher, and the anguish the child went through could possibly/probably have been avoided if the details of the care plan had been made available to her. Although this is just one example, I have been given a whole range of reasons why information sharing was withheld. One that stands out was how there was a belief that a pupil had moved to a new school for a ‘fresh start’ and therefore a care plan wasn’t necessary. This one for me is hugely negligent, both on the behalf of the staff but also the pupil. By all means, allow the pupil a new beginning, but the responsibility to safety has not diminished in anyway, and until it can be suitably demonstrated the challenging behaviour no longer poses a threat, the risk assessment should stay in effect. Justifying your actions to others Reporting is not just about informing risk assessments or positive behaviour support plans. A robust reporting mechanism is powerful tool to collate evidence to underpin why as a teacher, you responded in a particular way, and the decision-making process behind that action. Technically, if we restrain an individual we are assaulting them and restricting their liberty, which is a breach of their human rights. Now, provided we can justify our actions we have a suitable legal defence and no charges relating to the ‘assault’ should be brought. Avoiding the ‘it’s your word against theirs’ So, how can we ensure this justification is communicated clearly to those with a vested interest? With the creation of an accurate and detailed report. To quote the old Police and HM Prison Service maxim, ‘if it ain’t written down, it didn’t happen’. In other words, if you don’t create a report of an incident, all sorts of allegations can be made, and it is ‘your word against theirs’. By writing a report you have created your evidence, your defence to your actions as seen ‘through your eyes’. Again, you are ‘painting a picture’ of what happened so that any reasonable person looking at it would likely respond in the much the same manner. Report writing also documents the particulars immediately after the incident. Most investigations and related legal cases occur many months, if not a couple of years after the incident, and as time passes it can get increasingly more difficult to remember exactly what happened and in what order. By recording the incident in a report, you have an aid to memory when it comes to explaining yourself during an investigation. Investigation?! Should I be worried? In short, no. An investigation is simply that; an investigation. A method of finding out the facts of any given subject. How can the facts relating to your actions be discovered during an investigation? By the use of a report… are you seeing a pattern here? Ok, you’ve banged the drum about reports. What can I do? We cover report writing in all of the restraint and positive handling courses we deliver. Alternatively, get in touch with us at COVIC Training Solutions and we can discuss what you need to do to create an accurate and detailed incident report.

I’m going to start this piece by saying I disagree with the Care Review and the related article in The National , and the concept of banning restraint, physical intervention, safe holds (insert preferred term here). Why is that? Isn’t finding an alternative to restraining an individual, whether it is a child or adult a much better outcome for all? Well, in an ideal world yes. Never having situations where restraint is the only viable option to keep an individual or other people safe would be fantastic. Service users would benefit as not many people like to be restrained. Staff would benefit as they would no longer have to put themselves in danger of physical injury by restraining a service user. Unfortunately in the real world, this simply isn’t the case, and here is why. Before we go any further, for the purposes of this article and the ease of writing, all physical intervention methods that involve the direct application of force to restrict the movement of an individual will be referred to as ‘restraint’. What about the risk assessment? Firstly, if an organisation, school, care facility has a restraint policy it should be informed by a risk assessment. That assessment will be a measurement of known and likely risks that an individual, or groups of individuals may pose to themselves or others. If that risk is present the organisation must, by law, implement all reasonable actions and measures to eliminate or reduce that risk. If the identified risks include violence, aggression, self-harm or any threat to the physical welfare of a service user or others, then appropriate measures must be put in place to prevent or reduce those risks. Secondly, if a risk assessment has been carried out and the risk of violence, aggression, self-harm etc. has been identified, but the organisation only goes so far in its reduction of risk to the point where those measures are not fit for purpose, the organisation is at risk of breaking the law. Low level strategies will only go so far in the management of aggression, and removing the option of reasonable force will raise the risk of harm to all. You can read more about risk assessments and risks to employees here. Would restraint reduction strategies work better? At COVIC Training Solutions, we are known as a leading training provider for restraint and personal safety training. That is a given. However, the bulk of what we actually teach could be described as ‘restraint reduction’ strategies such as conflict management, positive behaviour support, and effective communication techniques. Why? Because it has been proven time after time that strategies such as these significantly reduce the number of incidents an organisation may experience. Furthermore, the ethos of any given organisation has a huge impact on the mind-set of its staff. Ultimately it is right that we do all in our power to NOT use force . With that said, we must also prepare to have to use force if a particular situation makes it a necessary option. Does the Care Review raise important issues? The report from the Care Review raises some very salient points, particularly around the use of restraint as a form of abuse and/or punishment. I completely and unreservedly agree with the Care Review on this. Restraint should NEVER be used as such, and should only be used in the prevention of harm. The Care Review also highlights a few techniques that potentially increase the risk of harm during an incident. Again, I completely agree with their findings. So should restraint be completely banned? Absolutely not! There are many restraint packages available, and some are better than others, but those that are worth their weight in gold are those that work and are safe. A simple analogy that works for me is ‘cars have killed many people so we should ban all cars’. Is this a reasonable measure? Of course it isn’t. The need for transport is still there. The need for people and businesses to get around the country hasn’t gone away, and the same can most certainly be said about the risks some service users pose. Banning restraint doesn’t reduce the risk. Is the Care Review keeping people safe? In short, if the Care Review can guarantee carers, and anyone working with service users will not be put at risk by aggression and violence from service users, and never have to manage incidents of self-harm, then I will be at the forefront of having restraint banned in all organisations, and will then have to find another job. Until then, I will continue to train staff in safe, appropriate, and effective methods of restraint alongside actively promoting methods of how to minimise the need for it. A final thought… Let’s consider the ramifications on the carer/teacher/someone in charge of a young person. If a service user physically attacks a carer , teacher, member of staff and that staff member fears for their life and uses reasonable physical force to stop the assault from continuing, should that carer be punished? Should they lose their job? I’ll take that thought further. The carer has been told restraint is no longer an option so the carer decides their only option to protect themselves is to strike the service user. Again, should the carer be punished? Should they lose their job? Are the Human Rights of the carer not as important as those of the service user? Should carers just expect that their life is put on the line when giving care?

Violence in schools is on the increase with recent statistics painting a startling picture of the changing education environment. The growing knife culture is bringing a new level of threat to both our children and teachers within schools. So what do you do if you find a knife?

Safeguarding in schools is and will always play a vital role in preventing harm. Reflecting on recent news highlighted the seemingly common occurrence of getting the basics wrong. This blog considers how governmental guidance, adequate risk assessment and policy writing underpins good safeguarding practice.

I recently spoke to a Door Supervisor who operates in a city in the Midlands, exchanging stories of our experiences and working practices. I asked him about the use of handcuffs by Door Supervisors in the city and in particular how Police Officers reacted to Door Supervisors carrying cuffs. He explained that handcuffs are not allowed by private security personnel in the city and Police Officers confiscated cuffs from Door Supervisors. Worryingly, he explained that one Saturday night while on duty a Police Officer confiscated his cuff key, used to lock and unlock the cuffs, leaving him with just the handcuffs. Later that evening a Police Inspector confiscated the handcuffs explaining that only Police Officers were allowed to carry and use handcuffs. Is this the case? Are only Police Officers and those involved in law enforcement allowed to carry and use cuffs? In short, no. Technically you and I as civilians are, by law, allowed to carry and use handcuffs. However, before you rush out and buy a set ‘because Colin from COVIC said so’, there is a mass of information you need to understand first. Ultimately you need to be trained in the reasonable use of handcuffs and they need to be of serviceable and fit for purpose quality. Ideally you would also be trained in restraint as this is good practice and you will understand the concepts of reasonable force. A handcuff training course not only teaches you how to apply cuffs, but also the underpinning legislation in relation to their use, some of which we will look at now.

All too often I have heard various misconceptions about the term ‘self-defence’ and what does and does not constitute a legally accurate and a fit for purpose description of this term. I have heard people at one extreme say “He hit me first so I hit him back; it’s self-defence” through to the other extreme of “You can’t do anything by law if a pupil attacks you or it will be assault against a child”. Both of these extremes are incorrect and incredibly dangerous for varying reasons as you will soon find out. I aim to not only explain what self-defence is but also give you the tools with which to look at other instances of self-defence or use of force so you can judge for yourself if the force was legitimate or assault.

I recently received an amusing email from a friend that spoke about an experiment involving a number of monkeys, a ladder, some bananas and a cold shower. After reading the email and agreeing with its sentiments, I realised that it struck a chord with me and I couldn’t shake off the message it conveyed. I conducted a little research into the alleged experiment to find that it did actually take place back in 1967 as an experiment into ‘mob culture’. The experiment goes along the lines of a group of scientists placed 5 monkeys in a cage. In the middle was a ladder with bananas at the top. Every time a monkey went up the ladder, the scientists showered all of the monkeys with cold water. After a while, every time a monkey went up the ladder the other monkeys beat him up. After some time no monkey dared climb the ladder, regardless of the temptation. The scientists decided to substitute one of the monkeys. The first thing the new monkey did was climb the ladder to get the bananas. Immediately the other monkeys beat him up. After several beatings the new member learned not to climb the ladder, although never knowing why. The second monkey was substituted and the same occurred. The first monkey participated on beating the second monkey. A third monkey was substituted and the same was repeated. The fourth was substituted and the beating was repeated, and finally the fifth monkey was replaced. What was left was a group of 5 monkeys that even though never received a cold shower, continued to beat up any monkey that attempted to climb the ladder. If it were possible to ask the monkeys why they beat up all who attempted to climb the ladder, I bet their answer would be: “I don’t know, that’s how things are done around here”. Now I’m fully aware that we’re discussing monkeys and we’re human beings and as such we’re obviously far more evolved, developed and intellectually advanced than our genetic cousins… but just how much more advanced are we in our rationale and thought processes? In 2004, Edgar Schein discusses “unconscious, taken-for-granted beliefs, perceptions, thoughts and feelings. The ultimate source of values and action” (Schein, 2004). This is the element you see or experience but it is difficult to understand ‘the why’. Often these assumptions conflict with the ‘values’ promoted on posters and intranets or discussed in inductions. For instance, a healthcare organisation is extremely proud of their strong culture and ethos of caring for patients. From their new employee induction and orientation program to their performance management program, everything focussed on caring, quality and more importantly for this example, speaking up when they saw something wrong. Several years ago, a new nurse just out of induction publicly corrected a physician and was openly “flogged” in front of colleagues, patients and superiors. That nurse later became a mentor to several other nurses, and quickly explained that what they learned in orientation about speaking up was a bad idea, and they would actually be subject to disciplinary action if they challenged a physician or a more senior nurse. Year after year, the unspoken rule is handed down and the energy and excitement of hearing the values at induction gives way to cynicism and silence. The same occurs within the realm of understanding reasonable force and its application. All too often I have heard staff within care homes, schools and hospitals tell me that it is illegal to use physical force to prevent someone harming themselves or another. It is assault to use physical force to use force to protect oneself from attack, particularly if the assailant hasn’t actually struck first. However, when I have asked the usual question “Who told you that?” the response is usually a manager, a supervisor or another colleague. Quite often they cannot remember who told them; however, they perpetuate the myth based on misinformed assumption through ‘the ranks’. The result? Reduced morale, staff feeling unsupported and more importantly, staff feeling unsafe and even scared. Don’t be the monkey! Get informed, do your own research and ask questions. Information is readily available from a wide variety of sources including the internet, the Government legislation website, and industry specialists like the team at COVIC Training Solutions.

Dudley hospitals deny 'unlawful restraint' of patients Staff at an NHS Trust in the Midlands have been accused of unlawfully restraining patients , including a 14 year old child. The allegations are thought to have been made by the Trust’s former head of security, but the claims are denied by Trust Chief Executive Paula Clark.

If so then you owe a duty of care to employees, service users, and visits as enshrined in UK law, and this is inescapable.