IN 2020 “I can’t breathe” was heard across the world in response to the racist murder of George Floyd and others by US police officers — but restraint isn’t usually caught on a smartphone.

In Britain, most of these violent and restrictive practices occur on mental health wards.

Those affected are hidden away, their families on a seemingly never-ending search for justice.

Kyle*, a teenager, was pounced upon by at least seven men in an incident in 2015.

They tackled him to the floor. A large man straddled his back, his hands squashing Kyle’s face onto the rough carpet.

With his body crushed, he gasped for air. The other men trapped his legs and arm in place using their knees, while another yanked his arm across his back, which made Kyle howl in pain.

Then, in front of all those watching, his jeans were pulled down to his thighs and he was jabbed with a needle.

When Kyle was finally free, his arm was broken and required a complex operation to attach metal plates to the damaged bones.

One would expect these men to be charged for this assault but because they were nursing assistants and justified the restraint as necessary in order to deal with his challenging behaviour connected to his ADHD and learning disabilities, the managers did nothing. Police Scotland also refused to get involved.

This means Kyle, who is still a patient, is tormented each time he sees these staff members on the ward.

His arm will cause him problems for the rest of his life, with the pain and restricted mobility another reminder of the trauma he suffered under the hands of those supposed to care. 

His mother Tracey said: “Kyle used to be bubbly, with a keen interest in studying, swimming and cooking but with him in the mental health system exposed to physical and chemical restraint his mood, outlook and trust has been affected.”

The administering of intramuscular (IM) injections with strong sedating and anti-psychotic drugs, sometimes described as a “chemical cosh” or “chemical restraint” are often used during physical restraints.

This is also what happened to Dani, who used to be a bright young girl. She is diagnosed with an eating disorder and emotionally unstable personality disorder.

On her first admission, she was restrained physically and chemically multiple times.

Dave, her father, noticed just how frequent patients, including Dani, were restrained using IM injections of anti-psychotics, often without any attempts of de-escalation.

Sometimes, Dave was informed this had taken place but more often not.

Before long Dave noticed a pattern. First, these IM injections were often used as a first port of call. This runs contrary to all the guidance given regarding restraint.

Second, chemical restraints usually took place during nights and weekends, when staff numbers were low. This suggests that chemical restraint was used as an easy way to manage patients.

Finally, chemical restraint was used as an all too convenient reason to stop privileges: “Dani had Section 17 local leave,” Dave said.

“We drove the 170 miles — 3½ hours — on a Saturday morning only to be told on arrival her leave was cancelled due to the IM injection administered the night before.”

As Dani was dragged through the mental health system, her father witnessed the deterioration brought on by the treatment she received.  

“Before being an inpatient on mental health wards, Dani was a very bright, intelligent young lady.

“She read voraciously, loved horse riding and at school she had a blossoming talent as a writer. Now, this has all gone,” Dave said.

“She has become very institutionalised, needing a set routine and gets very agitated and upset when routines are broken.”

The justification for restraint is often said to be preventing harm to the service user or others.

But it is often the act of “restraining” patients in itself that’s causing injuries — in some cases resulting in lifelong disabilities and even death.  

Even when injuries aren’t acquired, restraint can lead to an erosion of trust, with patients unsure whether the staff member they approach will be caring or violent.

For Janice, Gary and their daughter, Clare, who has obsessive compulsive disorder (OCD), an eating disorder and is also on the autistic spectrum, the chameleon nature of some staff is something they all recognise.

On one mental health unit, their daughter was treated in a brutal and punitive manner, by those paid to care.

When she would fight back or struggle, they would restrain her, often for hours on end.

“Many times, we were not even informed about the restraint.  When we were told, no matter who we complained to whether that be the Health Care Inspectorate or safeguarding team, nothing happened,” Janice said. 

Clare was then transferred to yet another unit, but this wasn’t based on her care needs, instead it was because the trust were irritated by these “complaining” parents.

Keir Harding, clinical lead of Beam Consultancy, who works with enlightened trusts to avoid out-of-area placements said: “In my experience any parent who identifies that what is being done is making things worse rapidly gets seen as the problem.”

Restraint can also be particularly threatening for those who have survived sexual assaults. 

As Harding said: “If part of your life has involved being forcibly held down and something inserted inside of you, it will make sense that re-enactments of that experience in a hospital ward will compound the trauma of the original assault.”

With the introduction of training for staff and (soon to be) new legal requirements, it is hoped that soon such violent practices will become a thing of the past.

PRICE Training, which is specifically for children and young people, is designed to help staff manage physically challenging behaviour in the least restrictive way, focusing heavily on de-escalation and diversion techniques before any physical force.

For adults, initiatives such as No Force First, again focus on what can be done to de-escalate a situation.

These initiatives chime with the guidance from the Department of Health that states restraint “should only be used as a last resort.”

Yet, in 2019 patients were restrained over 38,000 times.

These numbers are likely to be higher because not all incidents of restraint are recorded as they should be.

Research has shown that disproportionately those who are young and black, as well those with learning disabilities are more likely to be subjected to violent restraint than other groups.

The Mental Health Units (Use of Force) Act (2018), also known as “Seni’s Law,” was the legal response following the death of Olaseni Lewis, a 23-year-old black man who died after being held in a prolonged restraint by 11 police officers when he was a voluntary inpatient at the Bethlem Royal psychiatric hospital in London.

The aim is to curb the use of dangerous restraint methods.

The units must provide training for staff which includes:

• Showing respect for patients’ past and present wishes and feelings,
• Avoiding unlawful discrimination, harassment and victimisation,
• The use of techniques for avoiding or reducing the use of force,
• The risks associated with the use of force,
• The impact of trauma and force (whether historic or otherwise) on a patient's mental and physical health

Each incident must be fully recorded, and if police are called, body cameras must be worn.

It all sounds so promising. The only problem is this law is still in limbo after two long years, and nobody can give a satisfactory reason as to why.

Paul Farmer from Mind said: “This law will reduce the use of force and help improve the safety of people experiencing a mental health crisis.

“It has the potential to put an end to any more devastating and inexcusable deaths, like Seni’s, which should never have happened in the first place … People need help, not harm.”

It is yet to be seen when these new legal requirements will come into force and whether they will curb restraint or be a way for some providers to get around the rules in order to justify it.  

In 2021, all service users should expect safety on mental health wards.

The fact they can’t yet be promised that is shameful and should concern us all.

We simply wouldn’t accept it if a large proportion of those going into hospital for treatment or an operation were pounced on by nurses and returned home with black eyes, broken bones, or worse.

So why do we still find it acceptable in mental health?

*Some names have been changed to protect confidentiality.

Ruth F Hunt is a freelance journalist and the author of The Single Feather (Pilrig Press). Keir Harding is clinical lead at the Beam Consultancy (www.beamconsultancy.co.uk).