Lack of staff training puts mentally ill at risk on wards

The death of a psychiatric patient held face down for 25 minutes has highlighted the repeated failure of ministers to heed warnings from coroners and doctors
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A coroner has written to the Government's Chief Medical Officer seeking action after a mentally ill man died while being restrained by inadequately trained hospital staff.

Geoffrey Hodgkins, 37, died in 2006 after being held face down for 25 minutes by seven staff, including security guards, after throwing a cup.

The coroner's request comes after long-standing calls for a national system of training for hospital staff working with mentally ill patients. This was first recommended after the death of psychiatric patient David "Rocky" Bennett 10 years ago.

The subsequent inquiry into Mr Bennett's death urged the Government to roll out a national programme within 12 months, and to keep a check on the use of restraint in psychiatric hospitals. But ministers have failed to approve funds to establish a national system, The Independent on Sunday can reveal. It is not known if any other psychiatric patients have died while held under restraint, as figures are not recorded.

Bruce Hodgkins believes his brother died needlessly, saying: "Restraint and inept practice caused his death. We would like to know how many patients in psychiatric hospitals have died while they have been in discussions about funding."

David Horsley, the Portsmouth coroner in charge of the Hodgkins inquest, said last week: "I have written to the Chief Medical Officer at the Department of Health requesting clearer and more detailed guidance to be put out to NHS trusts, to help them in turn devise effective and safer restraint protocols."

He went on: "My concern is that bodies such as NHS trusts have to implement restraint techniques unsupported by adequate practical guidance on how to do so. I hope coroners can assist in drawing to the attention of those responsible for providing that advice the urgent need for it."

The Government's failure to act is set against growing evidence of widespread use of physical restraint in overstretched mental health wards. In new research by the Royal College of Psychiatrists and the NHS watchdog the Healthcare Commission, a fifth of clinical staff and more than a third of non-clinical staff, such as security guards, said they did not have adequate training in dealing with violent incidents.

Sue Bailey, registrar of the Royal College of Psychiatrists, said: "Control and restraint is a core skill within mental health. It can be life saving but if it goes wrong it can go the other way. How can it be inherently different across the country? We would not accept variations in practice for cardiac resuscitation, so we shouldn't for mental health."

Officials in charge of the Rocky Bennett inquiries have expressed deep concern at the lack of progress made since then. William Armstrong, the coroner in the case, said: "Clearly, David Bennett died while being restrained inappropriately by staff without proper training. I highlighted this as a national issue in the inquest report and this was substantiated by the public inquiry. So it is of deep concern that there is still no national system of proper training."

Sir John Blofeld, the retired High Court judge who led the independent inquiry in 2004, said: "We spent a lot of time making carefully considered recommendations and it is disappointing if no actions have been taken. If the police and prison services can issue control and restrain guidance, this ought to be possible for mental health staff. I wish to goodness they would get on with it."

The Government rejected the report's advice for a three-minute limit on restraining patients in the prone position, but has failed to come up with a safer alternative. Hospitals continue to use a variety of techniques, and the instructors employed to train staff remain unregulated.

It did establish the Management of Violence project to examine the evidence and propose safe solutions but has failed to finance the proposals made.

Colin Dale, joint project manager, said: "In 2006 we submitted proposals for the regulation of trainers, so they all meet minimum standards, and for national guidelines, so what people are taught is the right thing. If these were implemented they would go far beyond what the coroner proposed."

A Department of Health spokesperson said funding was under discussion but declined to comment further.

Meanwhile vulnerable mental health patients continue to be restrained by inadequately trained staff. Stuart Wooding, 61, was held face down for more than 10 minutes by three members of staff. He believes the situation was handled badly because staff were poorly trained. "I felt bullied on the ward and got so angry I ended up trying to kick someone," Mr Wooding said. "Next thing I was being held down with my arms behind my back, in so much pain I soiled my trousers. The nurses should have helped me to calm down rather than physically controlling me."

Sophie Corlett, policy director at the mental health charity Mind, accepts some hospitals have high standards of control and restraint practice but believes all vulnerable patients have a right to be safe: "No one should be working on a ward without having had high-quality training in de-escalation and control and restraint. It's crucial for the safety of both patients and staff, and it's no exaggeration to say that it could save lives."

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