Rise in Use of Physical and Chemical Restraint on Vulnerable People during COVID Pandemic ‘A Public Health Emergency’

Rise in Use of Physical and Chemical Restraint on Vulnerable People during COVID Pandemic ‘A Public Health Emergency’

Katharine Quarmby reports how ‘out of sight, out of mind’ sedation and seclusion seems to be replacing what little care there was before for those with learning disabilities, older people, and individuals with mental health problems

Some forms of physical restraint kill – that’s the stark message of recent cases whereby people, often from ethnic minority backgrounds, have been killed by police officers kneeling on them or using other dangerous holds.

It is an awful litany both in the US and UK – George Floyd; Tanisha Anderson; Dalian Atkinson, a British footballer with renal failure who appeared to be experiencing a mental health crisis when he was fatally restrained by police officer Benjamin Monk in 2016. Monk was convicted of manslaughter last week.

These shocking cases of fatal physical restraint are just the tip of the iceberg, hidden mainly because most so-called restrictive interventions – used in the criminal justice system, health and social care, and increasingly in education – take place out of sight, often behind closed or locked doors.

These practices are supposed to restrict an individual’s movement or liberty only either to take control of a dangerous situation with the possibility of harm to the person or others, or to end a dangerous situation. They include physical restraint – including painful holds in some settings; mechanical (tying and securing); and chemical, using drugs to subdue. Seclusion is also frequent.

In reality, restrictive interventions are over-used and under-scrutinised. Certain groups – notably disabled people, older people and people with mental health problems – are particularly at risk. 

During the Coronavirus pandemic there appears to have been a shift from physical restraint requiring close contact, to segregation and chemical sedation.

But things were already bad for people with learning disabilities, in particular, as the latest report from the LeDeR project, helmed by Bristol University, shows. Data from 2018 to 2020, analysed by Professor Chris Hatton of Manchester Metropolitan University, demonstrates that a high proportion of adults who died during that time had been given a powerful cocktail of drugs – more than six drugs per person. The most common drugs given were antidepressants and antipsychotics.

Poly-pharma prescribing to people with learning disabilities isn’t new – they are often labelled as challenging and their behaviour then controlled through drugs, although disability rights advocates argue that so-called challenging behaviour can often be a form of communication. The reasons given for prescribing antipsychotics were distinctly odd – including hay fever, autism and sedation. Reasons for prescribing antidepressants (affecting 28% of those who died) included excessive salivation and autism. These aren’t good reasons for dosing people with powerful drugs.

Professor Hatton also points to other data covering everyone in inpatient mental health services, which shows that, during lockdown, oral chemical restraint, as well as rapid tranquillisers by injection, increased rapidly. During September 2020, 281 people in inpatient units were chemically restrained by mouth 748 times, with the figures increasing again in March 2021. An even higher number of people were rapidly tranquillised.

Older people with dementia have also been affected. Dr Aida Suarez-Gonzalez and co-authors carried out a systematic review of people living with dementia during the pandemic and found studies describing increases of up to 20% in the use of antipsychotics and benzodiazepines.

Professor Hatton warns that the situation may be deteriorating as the pandemic continues. “The number of disabled children, adults and older people who are being subjected to dangerous levels and combinations of drugs to control their behaviour should constitute a public health emergency,” he told Byline Times.

Last year, the parliamentary Joint Committee on Human Rights took evidence about young people detained with learning disabilities or autism in mental health settings and how their care had been affected by the Coronavirus pandemic. It found that there had been a marked increase in the use of both restraint and solitary confinement.

Adele Green, mother of Eddie, a young man with a learning disability, told the committee that her son was “subject to restraint and seclusion and has been over-medicated, so he has been restrained through the medication as well” and that “he has experienced time in a seclusion cell within the hospital”.

Andrea Attree, whose daughter Dannielle has autism, said that her daughter was routinely restrained and subjected to solitary confinement in two rooms, then locked in one when unsettled. Danielle was so disturbed by being confined that, on one occasion, she used her own blood to write on the wall. Her mother reported that on another occasion she tried to break the CCTV so that staff would have to come in rather than just watch her. She was then grabbed, put face down and was bruised as she was taken to the ‘safety pod’.

The committee concluded that the increased use of restrictive practices during the Coronavirus pandemic amounted to a violation of the right to freedom from inhuman and degrading treatment. 

Beth Morrison, a leading parent campaigner challenging the use of restraint and seclusion in schools, told Byline Times that the use of seclusion had increased sharply during COVID-19. In particular, she pointed to the use of tents that could be zipped and locked shut with distressed children inside them. The tents are sold as sensory rooms to calm children down. Parents are campaigning for ‘Harry’s Law’, which would compel schools to report when they isolate or restrain a child. 

Headteachers’ union, the NAHT, has recently said that it is “deeply concerned” at the lack of new laws on the restraint or seclusion of pupils in schools, dubbing current laws and guidance as out-of-date.

In the UK criminal justice system and health and social care, restrictive interventions are, to some extent, monitored and regulated – though most critics argue that, in practice, reporting is very patchy. There is no monitoring or duty to report to parents in mainstream English and Welsh schools, whilst guidance is now being developed in Northern Ireland and Scotland. The Equality and Human Rights Commission is due to report on the rate of restraint and seclusion in English and Welsh schools later this month.  

The Council of Europe’s anti-torture committee recently concluded an investigation of the UK’s police, prison and psychiatric institutions, looking in detail at the impact of restrictions imposed during the pandemic, including increased use of segregation, seclusion and restraint. Its findings have not yet been made public.  

The pandemic has reduced the scrutiny required to protect vulnerable people in closed settings. Sedation and seclusion seem to be replacing what little care there was before – without a public outcry because so much of this harm is hidden from view.