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Date: November 25, 2024 Mon
Time: 8:07 pm
Time: 8:07 pm
Results for restraint
3 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 |
Author: Dale, Colin Title: Review of International Evidence and Practice on Non-Pain Inducing Techniques and Systems of Restraint Summary: In 2011, the Restraint Advisory Board (RAB), which was established to assess Minimising and Managing Physical Restraint (MMPR) for use in secure training centres (STCs) and under-18 young offender institutions (YOIs), recommended that research was commissioned: "...into the feasibility of developing a restraint system which does not incorporate pain induction techniques. The research should include assessing the applicability of restraint systems used in other sectors (within and outwith child care) that do not rely upon or permit pain induction". A review of existing evidence was commissioned in 2013 following this recommendation. The aims of the study were to: - identify, review and assess non-pain restraint techniques employed in different institutional settings across different countries (including England and Wales), and their effectiveness - assess the feasibility of implementing similar restraint techniques from other countries and settings within the under-18 secure estate in England and Wales. The research comprised a rapid evidence assessment of the relevant international research literature. This was followed by interviews with an international group of 26 practitioners, academics, trainers and managers about the use of non-pain inducing restraint techniques. The review of the existing research found only five relevant studies, none of which clearly and rigorously demonstrated the effective use of non-pain inducing techniques to control serious or volatile situations involving children and young people. These findings mirrored the conclusions of an earlier systematic review on physical interventions and seclusion in psychiatric settings following National Institute of Clinical Excellence methodology. The interviews with practitioners found that although non-pain restraint techniques were in use in various settings around the world, it was very difficult to identify approaches based on good-quality research on their impact. It was also apparent that the choice of restraint method employed varied depending on context and circumstance. As a result, the study concluded it was not possible, on the current evidence available, to identify a particular safe, more effective system of non-pain inducing restraint readily available to specifically manage volatile and serious situations within the youth secure estate in England and Wales. The study highlighted the need for more robust research in this area. 3 Details: London: Youth Justice Board for England and Wales, 2016. 35p. Source: Internet Resource: Accessed July 20, 2016 at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/521046/Non-pain_report_FINAL_22_Apr_2016.pdf Year: 2016 Country: International URL: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/521046/Non-pain_report_FINAL_22_Apr_2016.pdf Shelf Number: 139723 Keywords: Aggressive BehaviorAt-Risk YouthJuvenile DetentionRestraint |
Author: Howard League for Penal Reform Title: The Carlile Inquiry 10 years on: The use of restraint, solitary confinement and strip-searching of children Summary: The report, The Carlile Inquiry 10 years on, looks at what progress has been made since the Howard League published the findings of the inquiry. In the 10 years since the inquiry concluded, there has been much progress in youth justice, not least the reduction in the number of children in custody in England and Wales. Despite this decrease in the number of children the majority of children are detained in institutions where restraint is routinely used. In relation to the three specific areas that the inquiry looked at - restraint, solitary confinement and strip-searching - there have been some improvement but fundamental concerns remain. The slow and piecemeal progress in implementing the recommendations of the 2006 inquiry means, that 10 years on, children continue to be placed in danger and, because of poor and erratic treatment, they continue to reoffend. Details: London: Howard League for Penal Reform, 2016. 8p. Source: Internet Resource: Accessed July 20, 2016 at: http://howardleague.org/wp-content/uploads/2016/06/Carlile-Inquiry-10-years-on.pdf Year: 2016 Country: United Kingdom URL: http://howardleague.org/wp-content/uploads/2016/06/Carlile-Inquiry-10-years-on.pdf Shelf Number: 139747 Keywords: Juvenile DetentionJuvenile OffendersRestraintSolitary Confinement |