3Use of restraint and solitary confinement
Young people’s experiences of restraint and solitary confinement during the pandemic
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Adele Green, mother of Eddie, a young man with a learning disability: “Unfortunately, Eddie has been subject to restraint and seclusion and has been overmedicated, so he has been restrained through the medication as well. When he was restrained, because of the mix of staffing, types of restraint were used that possibly should not have been. There is an ongoing investigation into that, because he was harmed during it. He has experienced time in a seclusion cell within the hospital. Because of excessive head-banging when he was not coping, it was deemed that they needed to move him. It is mortifying to hear that all this is happening to your child.”13 Andrea Attree, mother of Dannielle, an autistic young woman: “[Dannielle] has been restrained most days over the last week or so. Most of those restraints, as Adele just said, are not appropriate. She knows the rules and regulations and will report that back to me. Because it is mainly agency staff coming in, they do not always have the knowledge to respond as they should with Dannielle. She is in solitary confinement in two rooms. She has access between the two because there is a bathroom. When she becomes very unsettled, they lock her in the one room. That restricts her further.”14 |
14.Andrea and Adele both told us that their children had been subjected to increased use of restraint; seclusion (possibly amounting to solitary confinement);15 and over-medication, during the period of the Covid-19 outbreak (see box above). There were several, often related, reasons for this, including; increased use of unfamiliar agency staff; measures taken to prevent the virus spreading within the institutions; and increased anxiety levels among young people due to the lack of family visits.
The right to freedom from inhuman and degrading treatment
15.The increased use of restrictive practices can create conditions that amount to a violation of the right to freedom from inhuman and degrading treatment (Article 3 EHCR). Article 3 requires the State to ensure that persons are detained in conditions which are compatible with respect for their human dignity, and that the manner of their detention does not subject them to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in such a measure.16
16.The evidence we heard from Adele and Andrea is that the conditions their children are being held in at present are extremely distressing. Andrea told us that in the 10 years in which Dannielle has been in and out of hospital she has never seen her so distressed. To communicate her desperation to staff, Dannielle has been self-harming and using her own blood to scribe on the wall.17 There is also evidence that restraint is not being used as a measure of last resort. Andrea gave us this example:
“[Dannielle] became very distressed on Saturday evening. The staff would not come in and talk to her. She climbed on a chair to break the CCTV so they could not just watch her from the viewing room; they would have to come into the room. They grabbed her from the chair and put her face down in the safety pod. She has a bruise on her nose and grab marks on her arms.”18
17.In both Eddie and Dannielle’s case it is they themselves who have told their mothers about the use of restraint on them and alerted them when the wrong types of restraint have been used, causing them pain and injury. In the 2019 report the Committee recommended that on every occasion that anyone is restrained or kept in conditions amounting to solitary confinement their families must be automatically informed. Families continue to be kept in the dark about what is happening to their loved ones without such a requirement in place.
The incidence of restrictive practices
18.We asked the witnesses from NHSE and the Care Quality Commission (CQC) whether the use of restraint and solitary confinement in these institutions was going up or down during the lockdown. Dr Kevin Cleary from the CQC told us that the data they have received does not yet show a clear pattern, however it has increased in some organisations.19 Claire Murdoch, from NHSE, reported that there had been no increase in the trend of long-term segregation or seclusion. In relation to the use of restraint she said that they did not have contemporaneous enough data to say definitively whether the use of restraint had risen or not but based on intelligence they had received they did not believe it had.20
19.The apparent discrepancy between NHSE data and that provided by the CQC highlights the urgent need for more accurate information in real-time. An independent task force was set up by NHSE in October 2019 to improve specialist children and young people’s inpatient mental health, autism and learning disability services in England, overseen by the Children’s Commissioner. We are encouraged to hear they are doing work in this area. The current situation means that accurate and trusted statistics are needed more urgently than ever.
Conclusion
20.Restraint must only ever be used as a last resort where absolutely necessary. Solitary confinement of children, and prolonged solitary confinement of adults, is contrary to the UN Mandela Rules on Prisoners and must be avoided. In order to understand how restrictive practices are currently being used, figures on their use, including physical and medical restraint and any form of segregation, detailing any incidences which go beyond 22 hours per day, must be published weekly by the institutions. These figures must be provided to the Secretary of State for Health and Social Care and reported to Parliament.
21.On every occasion that anyone is restrained or kept in conditions amounting to solitary confinement their families must be automatically informed.
15 The definition of solitary confinement is set out in the Istanbul Statement on the Use and Effects of Solitary Confinement: “Solitary confinement is the physical isolation of individuals who are confined to their cells for twenty-two to twenty-four hours a day. In many jurisdictions prisoners are allowed out of their cells for one hour of solitary exercise. Meaningful contact with other people is typically reduced to a minimum. The reduction in stimuli is not only quantitative but also qualitative. The available stimuli and the occasional social contacts are seldom freely chosen, are generally monotonous, and are often not empathetic.” Istanbul Statement on the Use and Effects of Solitary Confinement 9 December 2007 at p 1. The Istanbul definition is also used by the UN Special Rapporteur of the Human Rights Council on torture and other cruel, inhuman or degrading treatment, Juan Méndez, who referred to “solitary confinement” as “the physical and social isolation of individuals who are confined to their cells for 22 to 24 hours a day” and prolonged solitary confinement as exceeding 15 days. Report submitted to the UN General Assembly in August 2011 by Juan E Méndez, the Special Rapporteur of the Human Rights Council on torture and other cruel, inhuman or degrading treatment, paras 25 and 26.
16 Stanev v Bulgaria [2012] ECHR 46 (Application No. 36760/06)
Published: 12 June 2020