Restraint Review

Report: 10
Date: 29 July 2004
By: Commissioner

Summary

The Metropolitan Police Service has reviewed restraint and its approach to mental health issues following the inquest in October 2003 into the death of Roger Sylvester. Management Board will consider the final report in August 2004 and it will be available at the Full Authority meeting in September 2004.

A. Recommendation

1. That members note the progress of the MPS Restraint Review.

B. Supporting information

1. Following the verdict of unlawful killing at the inquest in October 2003 into the death of Roger Sylvester that occurred in January 1999, the Deputy Commissioner commissioned a review of restraint techniques and training with particular emphasis on mental health issues. This included an examination of the MPS response to HM Coroners’ recommendations following previous deaths in restraint. Commander Messinger oversaw the review.

2. The Restraint Review assembled a large quantity of written material about the medical conditions associated with acute behavioural disorder (sometimes called excited delirium). It has also consulted widely in the areas of mental health - both with the providers and users of services. For example, the Restraint Review has spoken to the organisation ‘Inquest’ and the firm of solicitors representing the Sylvester family, visited HM Prison Service Training Centre and Rampton Special Hospital to view their methods of control and restraint.

3. The Restraint Review commissioned CENTREX to provide an independent report into the delivery and quality assurance of officer safety training in the MPS. This report has been completed and provides a comparison of MPS training against the ACPO Officer Safety Manual and other forces.

4. The Restraint Review was further charged with examining equipment and has looked at a range of physical restraint devices available including leg restraints and a ‘net’. Trials of this type of equipment are presently taking place in the MPS.

5. In February 2004 two members of the Restraint Review visited Memphis to evaluate an alternative approach to policing mental health issues. Following a police shooting of a person suffering from a mental illness in the late 1980s, Memphis Police Department formed a Crisis Intervention Team (CIT) that comprises a number of specially trained patrol officers who can be dispatched from their normal duties to deal with a person suffering from mental illness. The CIT officers attend approximately 10,000 incidents a year. Their training involves de-escalation techniques. Mental health professionals commented that violent conduct was very rare after a person had been de-escalated by a CIT officer. The Memphis Police Department approach is integrated with the Regional Health Centre that takes immediate responsibility for the 5,000 individuals detained by CIT officers every year. This releases the CIT officers back onto patrol within 15 minutes. The initiative in Memphis has been very successful and implemented in some other US cities.

6. The Restraint Review has also considered the implications of the report of the Independent Inquiry into the death of David Bennett published this year. He died in restraint by nurses in 1998 at a medium secure psychiatric unit in Norwich. Sir John Blofield, a retired High Court judge, chaired the Inquiry and Professor David Sallah – a Professor of Mental Health at the University of Wolverhampton was one of the members. Professor Sallah participated in one of the consultations staged by the Restraint Review. The Inquiry made 22 recommendations including: that no patient should be restrained in the prone position for longer than three minutes; that the NHS should establish a national system of restraint and control within a year; no mentally ill person should be detained at any place unless there is a doctor present or available to attend within 20 minutes; a fully equipped resuscitation trolley and trained staff must be available wherever a mentally ill person is detained.

7. Use of the prone position was a key concern raised during external consultation. The Restraint Review has therefore considered how current guidelines and techniques could be changed to reduce the risk to individuals being restrained, police officers and the public.

8. On 11 March 2004 the MPS received HM Coroner’s recommendations under Rule 43 of the Coroner’s Rules 1984 following the inquest into the death of Roger Sylvester . His report contains seven “Matters for Immediate or Specific Action” – “to prevent similar fatalities in the short term” and three “Matters for further consideration” to prevent similar fatalities in the longer term, subject to further consultation, research, review and phased implementation.” The Restraint Review has considered HM Coroner’s report and proposes a number of recommendations to address the issues raised.

9. Management Board will consider the findings of the Restraint Review that principally focus on measures to reduce the risks associated with restraint including techniques and training. The Review suggests areas where greater collaboration with mental health partners would help to reduce risks and improve the quality of service provided to people suffering from mental illness. It also suggests that relevant issues should be referred to the joint MPA/NHS review of Mental Health e.g. quantifying mental health demands on the MPS.

C. Race and equality impact

1. The Restraint Review team was cognisant of the need to engage very broadly to gain an understanding of community concerns. Organizing and staging the consultation process was a very lengthy but vital exercise.

2. Non-government organisations consulted included the MPS Gypsy and Travellers Advisory Group, Lambeth Community Police Consultative Group, the Confederation of Indian Organisations, the National Assembly against Racism, TASHA Foundation, Barnet Carers Centre, the 1990 Trust and Ealing User Involvement Project.

3. Statutory bodies consulted included forensic pathologists, Authorised Social Workers, the Mental Health Commission, an Accident and Emergency Consultant and many other departments.

4. An Oversight Group to guide and inform the review was also formed. Its membership included the MPA (Richard SUMRAY), the (former) PCA, Superintendents Association, Metropolitan Police Federation, Black Police Association and mental health groups and IAG.

5. The aim of the Restraint Review recommendations will be to reduce the risk of deaths and injuries occurring in restraint. These should 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

Nil at this stage.

E. Background papers

None

F. Contact details

Report author: Chief Superintendent David Morgan

For more information contact:

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

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