Voices: The use of physical restraint on kids with eating disorders is harrowing
Warning: Contains information about eating disorders
Last year, a parent in my constituency got in touch to tell me they were struggling to secure a mental health bed for their child. Their child had been diagnosed with anorexia and needed urgent in-patient care. But because no mental health beds were available, they had to be admitted to a general medical ward instead.
While my constituent had not a bad word to say about the hospital staff, who were doing their best under the circumstances, they were extremely concerned that their child wasn’t receiving the mental health support they desperately needed – support that was clearly a prerequisite to their recovery.
When they first contacted me, their child’s condition had deteriorated to the extent that they were being restrained most days to be fed. The parents were worried that without specialist support, repetitive restraint was only making things worse.
Since this case was first raised with me, I have heard from countless eating disorder specialists, researchers, and medical staff about the rising number of children with eating disorders being restrained by staff without training in general medical wards.
I have heard harrowing stories of staff having to close entire wards to other patients because of the use of restraint. In other cases, security guards have been brought in to restrain patients. One organisation told me that they had started to provide mental health support to medical staff carrying out restraint under these circumstances.
The use of restraint and restrictive intervention is now widely recognised to have long-term consequences on the health and wellbeing of patients, as well as a negative impact on staff who carry out such intervention.
As a result, the Department of Health published guidance in 2014 stating that restraint by medical professionals should only be used in life-threatening situations and should be minimised across all adult health and social care settings.
Restraint in a mental health setting is regulated. Under Section 6 of the Mental Health Units (Use of Force) Act 2018, medical staff are required by law to record the use of restraint in all mental health settings. Section 7 of the act states that the secretary of state for health and social care must ensure that this record is published.
But this act only applies to patients being assessed or treated for a mental health disorder in a mental health unit – so there is no record of the use of restraint in general medical settings.
Last year, after this case was raised with me, I asked Steve Barclay, the health secretary, if he would publish all data his department holds on the use of restraint on acute child medical wards. The department’s response? They do not hold any data on the use of restraint on acute child medical wards.
This is a scandal waiting to happen. As a result of our chronically overstretched and underfunded mental health services, tier 4 specialist beds are hard to come by, so more and more mental health patients are being treated in general medical wards, where the usual guidance around the use of restraint – to only use it once all other routes have been exhausted – is not consistently applied.
The Royal College of Psychiatrists share this concern. They informed me that in the consultation for the 2018 Act, they questioned why it couldn’t be expanded to apply in all settings where people with eating disorders, or any other mental health conditions, are being treated.
Medical staff have an extremely difficult job to do in increasingly challenging circumstances, and there are many caring professionals providing excellent care and support to patients. Where good practice in reducing the use of force is taking place, we must learn from this and share these experiences and successes.
Take my own city, where Sheffield Children’s Hospital has started recording the use of restraint in general medical wards already. But for this to become commonplace it needs to be properly resourced.
In February during a debate in parliament for Eating Disorder Awareness Week, I raised this with the minister responsible for mental health. She said she would look at potential “loopholes” in the 2018 legislation – a welcome commitment to those who have raised the alarm.
However, despite subsequently writing to the minister, I have heard no word about how this is being taken forward. Parents and healthcare professionals deserve more than more empty promises.
The fight doesn’t stop with this issue. None of this would be happening if our mental health services weren’t stretched to breaking point. Yes, we need to tighten the laws so that guidance around restraint is followed.
But we also urgently need to direct funding towards early intervention, to reduce the number of people who end up in these critical conditions; we need to launch well-funded research programmes into the most effective, innovative treatments; and we need to adopt a holistic approach across the board, that centres preventative, community based, tailored mental health support.
In short, to truly address this crisis, we need a root and branch reform of eating disorder provision.
Olivia Blake is the Labour MP for Sheffield Hallam
For anyone struggling with the issues raised in this article, eating disorder charity Beat’s helpline is available 365 days a year on 0808 801 0677. NCFED offers information, resources and counselling for those suffering from eating disorders, as well as their support networks. Visit eating-disorders.org.uk or call 0845 838 2040.