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Date: April 29, 2024 Mon
Time: 9:52 pm
Time: 9:52 pm
Results for deaths in custody (united kingdom)
1 results foundAuthor: Caring Solutions (UK) Title: Review of the Medical Theories and Research Relating to Restraint Related Deaths Summary: The Independent Advisory Panel (IAP) which forms the second tier of the Ministerial Council on Deaths in Custody, commissioned this review of the medical theories and research relating to restraint related deaths. This report seeks to clarify research from national and international literature to ascertain any common findings in order to provide guidance for staff on safe and effective restraint techniques where there is no other resort in the management of violent and aggressive individuals. The methodology used was a literature review, a gap analysis and gathering expert opinion. There were 21 relevant international studies identified and 7 UK studies. There were 38 UK restraint-related deaths identified through NEXIS, INQUEST and a previous survey (which covered the period of 1979 to 2000). Of these 38, 7 were individuals detained under the Mental Health Act and 4 were informal patients in mental health care settings. Throughout the literature there is evidence that certain groups are more vulnerable to risks when being restrained, whether because of biophysiological, interpersonal or situational factors or attitudinal factors. These groups are those with serious mental illness or learning disabilities, those from Black and Minority Ethnic communities, those with a high body mass index; men age 30-40 years and young people (under the age of 20). The physiology of deaths under restraint in any setting where there is a duty of care on the state, is difficult to investigate as internationally the numbers of restraint-related deaths are small and classification by pathologists varies in different countries. Findings from experimental studies are not completely valid as there is limited generalisabilty to the real situation. The studies in this review which have increased validity are those with large numbers of retrospective case histories and autopsies but these are mostly published in literature from the USA. The frequency and acceptance of excited delirium syndrome as a cause of death in restraint incidents in this body of literature, and the use of ‘hobble’ restraint methods as the most common technique in these cases, make inferences and associations with UK deaths in custody more problematic. Simply restraining an individual in a prone position may be seen as restricting the ability to breathe, so lessening the supply of oxygen to meet the body’s demands. Restriction of the neck, chest wall or diaphragm can also occur when the head is forced downwards towards the knees. Laboured breathing and cessation of resistance may demonstrate collapse and indicate a medical emergency rather than cooperation from the individual. Other theories, besides positional asphyxia, were examined. These included acute behavioural disturbance and excited delirium, stress-related cardiomyopathy and the role of alcohol and drug abuse. Six of the thirty eight deaths noted in this report involved individuals with pre-existing conditions that may have increased the risk of cardiac arrest: e.g. ischaemic heart disease, diabetes and four people suffered from epilepsy. Sixteen cases had a history of mental illness, specifically psychosis. Positional asphyxia appears to be implicated in at least twenty six deaths (whether or not given as a verdict) because of struggle/physical stressors prior to restraint, number of staff involved and, in particular, because of the length of time of the restraint and position of the individual. Expert opinion and reviews were sought. There was consensus that there was a gap in reporting restraint-related deaths. Overall concerns were raised as to whether direct cause and effect can be determined in deaths as they often involve a mixture of complex factors and situations. The general view was that it should be assumed that everyone is at a potential risk rather than try to profile individuals only medically at risk. This is a class of death not fully understood and is multifactorial. Finally, a gap analysis was developed, including training and risk assessment issues, and implications for practice were discussed as a result of the expert opinion. Details: United Kingdom: Independent Advisory Panel on Deaths in Custody, 2011. 92p. Source: Internet Resource: Accessed on January 22, 2012 at http://iapdeathsincustody.independent.gov.uk/wp-content/uploads/2011/11/Caring-Solutions-UK-Ltd-Review-of-Medical-Theories-of-Restraint-Deaths.pdf Year: 2011 Country: United Kingdom URL: http://iapdeathsincustody.independent.gov.uk/wp-content/uploads/2011/11/Caring-Solutions-UK-Ltd-Review-of-Medical-Theories-of-Restraint-Deaths.pdf Shelf Number: 123733 Keywords: Deaths in Custody (United Kingdom)Mental HealthMentally Ill OffendersRestraint |