Restraint And Mental Health Review

Report: 11
Date: 30 September 2004
By: Commissioner

Summary

The final report of the MPS Restraint and Mental Health Review proposes measures to reduce the risks associated with restraint. It suggests areas where greater collaboration with mental health partners could help to reduce risks and improve the quality of service provided to people suffering from mental illness. It further suggests that relevant issues should be referred to the joint MPA/NHS review of Mental Health.

A full copy of the report has been circulated to members and available electronically.

A. Recommendation

That

1. approval to the recommendations of the Restraint and Mental Health Review be given; and
2. members approve the Implementation Plan for the recommendations of the Restraint and Mental Health Review .

B. Supporting information

1. Following the verdict of unlawful killing at the inquest in October 2003 into the death of Roger Sylvester in January 1999, the Deputy Commissioner commissioned a review of restraint techniques with emphasis on mental health issues.

2. On 11 March 2004 the MPS received HM Coroner’s report. It contains seven “Matters for Immediate or Specific Action” – and three “Matters for further consideration”. These have been taken into consideration in the final report of the Restraint Review that makes a total of 27 recommendations.

3. HM Coroner recommends first that sudden death during restraint should be recognised as a ‘multi-factorial concept’ and that the terms ‘excited delirium’ and ‘positional asphyxia’ should be removed from all documentation, guidance and protocols. The former PCA preferred the term ‘Acute Behavioural Disorder’. The Review agrees that the term ‘excited delirium’ should no longer be used but it believes that the term ‘positional asphyxia’ is well established, understood by operational staff and should therefore be retained.

4. HM Coroner also makes recommendations to health services about the need for improvements in policies, protocols and training. The Review has taken these recommendations into account in recommendations that will improve the information provided by officers when they hand over people detained under the Mental Health Act into health service care.

5. The Review sought to reduce the increased risks incurred during prolonged restraints. Current shortages of Sergeants may mean that a supervisor is not immediately available to attend a restraint while it is on going. The Review therefore recommends that one of the officers involved should take the role of Safety Officer to ensure the safety of the person being restrained, the police officers involved and the public.

6. HM Coroner expressed particular concerns about an apparent lack of techniques to re-position people, suffering from acute behavioural disorder, under restraint from the prone position. Concerns about the use of the prone position were also one of the major issues raised during external consultation undertaken by the Review. A time limit on the use of the prone position was considered – particularly in the light of a the three minute maximum period recommended by the Independent Inquiry into the death of David Bennett (2003).

7. The Review concluded that it is neither safe nor practicable to set a time limit for the restraint of a person in the prone position. Training should focus on achieving control and re-positioning an individual as quickly as possible stressing that the use of the prone position is only a mid-point in the restraint of a violent person. The Review also recommends in line with HM Coroner that the MPS should undertake trials of restraint equipment to assist officers to achieve and maintain control of a violent non-compliant person while avoiding adversely affecting the mechanics of breathing.

8. Medical opinion about acute behavioural disorder and restraint is diverse and sometimes conflicting. The Review therefore recommends that the Department of Health and Home Office should be requested to commission research with the aim of producing practical guidance for operational officers and health professionals to improve the care of people suffering from acute behavioural disorder. The Review further seeks to reduce the inevitable risks involved in restraining a very violent person in recommending that methods of achieving safe control from a distance should be investigated.

9. The Review makes a number of recommendations to improve the MPS response to incidents involving people suffering from mental illness. It recommends the appointment of a DAC to act as a champion for the MPS. The Review suggests the need for joint work with the NHS to reduce the time that patients are in police care, improve the ability of Accident and Emergency Departments to deal with violent individuals and reduce the need for police officers to restrain psychiatric patients in NHS premises. Furthermore the potential of multi-agency case conferences to reduce the risks of spontaneous incidents involving vulnerable people should be evaluated.

10. Improved communication between police and the mentally ill was a key issue raised during consultation. The Review has therefore recommended that all recruits and officers undergoing OST should receive specific training in de-escalation techniques with the aim of reducing the number of occasions physical restraint is required.

11. The Review compared the MPS restraint techniques with those employed by the health, prison and other police services. No substantial differences in techniques were identified when specific holds were analysed.

12. Centrex conducted an independent comparison of MPS Officer Safety Training (OST) with that provided by other police services. The MPS plays a pivotal role in the development of OST on behalf of ACPO. Informed by Centrex, the Review identified that the current MPS Manual has fallen behind the re-issued ACPO Manual. The Review therefore recommends that the MPS Manual should be updated and that ratification of additional staffing in the CO11 Officer Safety to ensure the quality of the delivery of training across the MPS.

13. Overall responsibility for implementation will be assigned to the DAC assigned as strategic champion. A Programme Board will be formed to oversee implementation of the recommendations. An Implementation Manager will be appointed to provide day-to-day leadership and coordination across functions.

C. Race and equality impact

The Restraint Review recommendations aim to reduce the risk of deaths and injuries occurring in restraint. Several of the recommendations respond to issues raised in consultation e.g. the need for officers to be trained in dealing with people suffering from mental illness and the need for better joined up working with the NHS particularly Accident and Emergency Departments. Their implementation should therefore improve the confidence of a number of groups within London who are presently concerned about sudden deaths in restraint and the MPS response to people suffering from mental illness.

D. Financial implications

Recommendation 18 - Video recording high risk pre-planned incidents - Dedicated camcorder for each Borough = £32,000

Recommendation 26 - Review the resources of the CO11 Officer Safety Unit - 6 Police Constables – formalising existing temporary arrangement = £206,736

Recommendation 24 - MPS produce a video about restraint to inform external and internal audiences. It may be viable to sell this video to other force’s to recover some costs - Production of video = £50,000

Recommendation 22 - IT based Use of Force Database - IT system to record relevant data = £100,000

Recommendation 7 - MPS should undertake trials of equipment (including Emergency Restraint Belts, VIPERS and others) - Purchase of equipment for use in trials = TBA

Recommendation 25 - The new MPS Officer Safety Training Manual should draw together disparate documents = £TBA

Total = £388,736

E. Background papers

Restraint and Mental Health Report, September 2004.

F. Contact details

Report author: Chief Superintendent David Morgan, Territorial Policing, TPHQ

For more information contact:

MPA general: 020 7202 0202
Media enquiries: 020 7202 0217/18

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