Policy briefing

Policy update: physical restraint in healthcare settings in England and Wales

Memorandam of Understanding clarifies when police and nursing staff should respond to incidents.

The Memorandam of Understanding clarifies when police and nursing staff should respond to incidents

Essential facts

In January, new guidance was drawn up for police and healthcare professionals, outlining for the first time how and when police officers should be involved in physically restraining people in healthcare settings in England and Wales. 

The Memorandum of Understanding, aimed at healthcare staff and police officers, clarifies when police should respond to incidents in mental health and learning disability settings, and the extent of their role should they be involved in a violent incident. 

The 28-page document was produced by the Mental Health and Restraint Expert Reference Group, chaired independently by Lord Carlisle and co-ordinated by the College of Policing. It was developed with the involvement of more than 30 healthcare organisations and people who have experience of being restrained. 

The guidance will be integrated into mental health Crisis Care Concordant local action plans in England and Wales. 

Overarching ethos

Research by the charity Mind in 2013 highlighted variations in the scale of involvement of the police during the use restraint in England and Wales. Physical restraint has led to injury and even death, and nurses and healthcare professionals are expected to ensure patient safety and minimise unnecessary police involvement in such incidents.

The memorandum of association says that each situation should be judged on case-by-case basis. For example, police officers should not be called to incidents relating to purely clinical interventions, such as taking bloods or giving injections, unless exceptional factors apply. These could include where an effort by staff to undertake a restrictive intervention has resulted in injury to staff that compromises their ability to continue safely, or where no other support is available in a timely manner to ensure the safety of all who are involved.

There are some situations where police attendance will be appropriate, including: 

  • Where there is immediate risk to life and limb – for example, the patient is yielding a weapon.
  • Where the patient is in possession of an offensive weapon.
  • Where there is risk of serious harm to staff.
  • Where the patient is causing serious damage to ward property – smashing up furniture and continuing to do so.
  • Taking a hostage and threatening to harm them if anyone enters the room.

Mental health services should involve people who use mental health services to gain an understanding from their perspective. This should be fed back to health commissioners to ensure that services are safe.

Police and healthcare staff should work closely and effectively together by sharing information and communicating clearly to guarantee the safety of patients and staff.

Health staff must alert police officers regarding any concerns about the patient’s welfare during any period of restraint

The document also highlights the need for senior nurses to share any concerns regarding police incident-handling. The document states: ‘Where the senior nurse has concerns about the appropriateness of the police response, they should escalate that to the duty inspector and to their own managers.’

Healthcare staff and police should also be committed to a collaborative effort to review and learn from incidents to prevent violent situations. The document provides guidance on post-incident procedures, with both police and healthcare staff recording details of incidents for joint-review. 

Nurses should also consider whether police involvement can be avoided by alerting healthcare managers in advance about patients who may require restrictive interventions as this will allow enough nursing staff to be available.

Memorandum of Understanding

Expert comment 

Photo: Tim George

Commander Christine Jones is National Police Chiefs’ Council lead for mental health

‘We know physical restraint can be humiliating, terrifying, dangerous and even life-threatening. For the first time, a Memorandum of Understanding has been agreed that sets a clear national position about when the police can be asked to attend mental health settings, for what reasons and what can be expected of them when they do attend.’

Ian Hulatt is professional lead for mental health at the Royal College of Nursing

‘This guidance offers clarity for police officers and mental health staff. It will help ensure the safety and dignity of patients, as well as the medical staff and police officers responsible for providing the care they need.’

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