This revised Code of Practice (‘the Code’) has been prepared in accordance with section 118 of the Mental Health Act 1983 (‘the Act’) by the Secretary of State for Health after consulting such bodies as appeared to him to be concerned and laid before Parliament. The Code will come into force on 1 April 2015.
This Code of Practice provides statutory guidance to registered medical practitioners, approved clinicians, managers and staff of providers, and approved mental health professionals on how they should carry out functions under the Mental Health Act (‘the Act’) in practice. It is statutory guidance for registered medical practitioners and other professionals in relation to the medical treatment of patients suffering from mental disorder.
26.70 patients should not be deliberately restrained in a way that impacts on their airway, breathing or circulation. The mouth and/or nose should never be covered and there should be no pressure to the neck region, rib cage and/or abdomen. Unless there are cogent reasons for doing so, there must be no planned or intentional restraint of a person in a prone position (whereby they are forcibly laid on their front) on any surface, not just the floor.
The Code applies to the care and treatment of all patients in England who are subject to the exercise of powers and the discharge of duties under the Act, including patients who are detained, subject to community treatment orders (CTOs) or guardianship, or on leave under the Act. The Act applies to England and Wales. Wales has its own Code that applies in Wales.
13.24: Restrictions (including restraint) and the deprivation of liberty should only be considered when absolutely necessary and when all appropriate efforts at building consensus and agreement have failed.
13.33 Sections 5 and 6 of the MCA offer protection from legal liability for certain acts of restraint – provided those acts are reasonably believed to be in the best interests of the individual. In this context restraint means using or threatening to use force to make a person do something they are resisting, or may resist, or restricting the person’s liberty of movement, whether or not the person resists.
13.34 In considering the use of restraint, decision-makers should carefully take into account the need to respect an individual’s liberty and autonomy.2 Section 6 of the MCA states that, in addition to needing to be in the best interests of the person who lacks capacity in respect of the relevant decision, acts of restraint will only be permitted if:
- the person taking action reasonably believes that restraint is necessary to prevent harm to the person who lacks capacity, and
- the amount or type of restraint used and the amount of time it lasts is a proportionate response to the likelihood and seriousness of that harm.
16.24 The use of physical restraint or force may be required when removing a person, or in a place of safety, for the protection of the person or others (such as the public, staff or patients). If physical restraint is used, it should be necessary and unavoidable to prevent harm to the person or others and be proportionate to the risk of harm if restraint was not used. The least restrictive type of restraint should be used. There should be a clear local protocol about the circumstances when, very exceptionally, police may be asked to use physical restraint in a health-based place of safety
26.56: The size and physical vulnerability of children and young people should be taken into account when considering physical restraint. Physical restraint should be used with caution when it involves children and young people because in most cases their musculoskeletal systems are immature which elevates the risk of injury.
26.67 Whenever restrictive interventions are being used, provider’s policies should make provision for the timely attendance of a doctor in response to staff requests concerning a psychiatric emergency whether in relation to medication, restraint or seclusion.
26.29: Physical restraint refers to any direct physical contact where the intention is to prevent, restrict, or subdue movement of the body (or part of the body) of another person.
26.70 Patients should not be deliberately restrained in a way that impacts on their airway, breathing or circulation. The mouth and/or nose should never be covered and there should be no pressure to the neck region, rib cage and/or abdomen. Unless there are cogent reasons for doing so, there must be no planned or intentional restraint of a person in a prone position (whereby they are forcibly laid on their front) on any surface, not just the floor.
26.71 Full account should be taken of the individual’s age, physical and emotional maturity, health status, cognitive functioning and any disability or sensory impairment, which may confer additional risks to the individual’s health, safety and well-being in the face of exposure to physical restraint. Throughout any period of physical restraint:
- a member of staff should monitor the individual’s airway and physical condition
to minimise the potential of harm or injury. Observations, including vital clinical indicators such as pulse, respiration and complexion (with special attention for pallor/discolouration), should be conducted and recorded. Staff should be trained so that they are competent to interpret these vital signs
- emergency resuscitation devices should be readily available in the area where restraint is taking place, and
- a member of staff should take the lead in caring for other patients and moving them away from the area of disturbance.
26.72 Where physical restraint has been used, staff should record the decision and the reasons for it, including details about how the intervention was implemented and the patient’s response.
26.73 If an individual is not detained under the Act, but physical restraint of any form is necessary, consideration should be given to whether the criteria in sections 5 and 6 of the MCA apply (restraint to be used in respect of people aged 16 and over who lack capacity) and/or whether detention under the Act is appropriate (subject to the criteria being met)
26.74 Provider policies concerning the use of physical restraint should be kept under ongoing review in order to ensure consistency with national policy and best practice.
26.98 Where rapid tranquillisation in the form of an intramuscular injection is needed, the person prescribing the injection should state the preferred injection site, having taken full account of the need to avoid prone restraint (i.e. where the person is forcibly laid on their front)
26.176 All staff who support people who are liable to present with behavioural disturbance should be competent in physical monitoring and emergency resuscitation techniques to ensure the safety of patients following administration of rapid tranquillisation and during periods of physical restraint or seclusion.
26.177 All clinical staff who undertake training in the recognition, prevention and management of violence and aggression and associated physical restraint should attend periodic refresher or update education and training programmes.
The full Code of Practice and the “easy read” version can be downloaded here.