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Monday 09 December 2019
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Women and girls and restraint by Katharine Sacks-Jones

Evidence is growing that there is a mental health crisis among women and girls in this country. 

One in five women has a common mental health disorder like anxiety or depression, compared with one in eight men. Young women are the most at-risk group for mental health problems and whilst the rate of suicide amongst young women is still much lower than for men it is now the highest on record. 

Report after report suggests that adolescent girls are suffering, with high rates of self-harm and depression. And we know women and girls are struggling to get the mental health support they need.

For those woman and girls who end up in mental health units for treatment, their expectations should be of a caring, supportive environment where they can get the treatment they need to get better. 

Unfortunately, we know from Agenda’s research on restraint that many are instead in an environment where physical force has become shockingly routine.

This is particularly concerning given the close links between women and girls’ mental health and trauma. 

More than half of women who have mental health problems have experienced abuse – and the links are particularly pronounced for those with more severe illnesses. 

So to be physically restrained – especially face-down, but also in other positions – has the potential to re-traumatise those who have suffered abuse.

Our figures – obtained through a Freedom of Information request sent to all trusts in England - showed that one in five women and girls were physically restrained in mental health settings. In some trusts that was as high as three quarters.

The use of face-down restraint continues to be widespread, with women and girls restrained in this way on thousands of occasions. 

The figures in Child and Adolescent Mental Health Services showed a particularly worrying gender disparity in the use of restraint.

More than 17 per cent of girls were physically restrained compared with less than 13 per cent of boys. More than eight per cent of girls were restrained face-down compared with less than six per cent of boys.

There were nearly 2,300 incidents of face-down restraint against girls, compared to fewer than 300 against boys. This suggests some female patients were restrained several times during a typical admission.

Being physically held down with clothes potentially pulled out of place, often in front of others, can be an extremely humiliating, as well as frightening, experience.

As such, the use of restraint is unlikely to improve mental well-being in the long-term – and will often do the opposite. 

Mental health nurses undoubtedly have an extremely difficult job to do in what are very challenging circumstances, with increasing pressures on time and staffing. 

However, that should not mean that restraint should be routine practice – and especially not against women and girls who have experienced abuse. It’s not good for patients or for staff. 

Some mental health trusts have clearly made an effort to reduce restraint – with a few appearing to have almost eliminated it. 

A recent study in the North West of England led by Professor Joy Duxbury from the University of Central Lancashire, trialled the use of the ResTrain Yourself approach aimed at reducing restraint. This included introducing trauma-informed care, working in partnership with patients, improving communication styles, changing the ward environment and having debriefs after incidents. 

Over the course of just over two years, four of the seven trusts had reduced restraint by 40 per cent. Overall, restraint rates across the seven trusts were 21 per cent lower than on comparator wards. Patients and staff also reported feeling more positive. 

This evidence shows that change is possible, and alternative de-escalation techniques can and do work. 

A growing number of women and girls are experiencing mental health problems – and with pressure on community mental health support, we know many women are unable to access help until they are at a crisis point. 

Those that reach that point and are admitted to mental health units are vulnerable and they need appropriate care and support. 

To help them get better, there needs to be a recognition of women and girls’ specific needs. Their histories of trauma must be fully acknowledged and support given to help them recover from their traumatic past and to tackle the underlying issues they face. 

With this in mind, it is clear that there is no place for face-down restraint in modern mental health settings and physical restraint should be used only as a last resort.

Only then can women and girls get the support they need in a truly safe and therapeutic environment. 

For more information about Agenda’s Women in Mind mental health campaign visit: www.weareagenda.org 

15 January 2018

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Katharine Sacks-Jones, Director of Agenda the alliance for women and girls at risk