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New guidance on restraining pupils with mental health difficulties

The Department for Education has published guidance aimed at reducing restraint of children and young people with mental health difficulties in special schools and health and social care settings.

In June 2019, the Department for Education published new guidance "Reducing the Need for Restraint and Restrictive Intervention". The guidance applies to children and young people with learning disabilities, autistic spectrum conditions and mental health difficulties and covers health and social care settings, as well as special schools. The guidance aims to help staff:

  • Understand the causes for behaviour that challenges
  • When that behaviour is more likely to occur
  • How children and young people can be supported to reduce the risk around those behaviours and to improve the quality of their life.

The definition of restraint is broad, covering physical restraint, but also extending to the use of threats, medication and even seclusion to restrain children and young people. Although it recognises that seclusion can be a form of restraint, it suggests that when it is used as a disciplinary penalty, such as an isolation booth, it will not classify as restraint.

The guidance recommends a series of actions for services to take to reduce restraint and restrictive intervention including:

  1. Having clear policies in place for reducing the use of restraint
  2. Knowing their legal duties around restraint
  3. Involving children, young people and their parents/carers decisions around behaviour and the use of restraint and developing their tailored behaviour support plans
  4. Managing behaviour that challenges in ways that have been proven to work
  5. Having measures in place for training staff who use restraint
  6. Continually improving management of risk to children and young people and staff
  7. Having clear systems in place for recording and reporting incidents of restraint
  8. Being able to identify patterns of when restraint is used
  9. Thinking about ways to improve the service so use of restraint can be reduced

Our thoughts

Whilst we're pleased to see the Department for Education bring forward guidance with a focus on children's rights, we have concerns about who and what the guidance doesn't cover.

Whilst services and staff should follow this, it's not legally binding. This means there isn't a duty to involve children, young people and their parents and carers in decisions around their behaviour nor is there a duty to record and report incidences of restraint. The guidance is silent on the need to tell parents/carers when their child has been restrained and fails to prohibit the use of prone restraint on children and young people. Mind have spoken out about the dangers of prone restraint on people with mental health problems and in 2013, we called for an end to its use in healthcare settings.

We have serious concerns that the guidance says that seclusion is not restraint when it is used as a disciplinary tool. We have previously written about the use of isolation booths, a form of seclusion, as a disciplinary tool and the devastating effect it can have on pupils with mental health problems. We have publicly warned about the lack of good guidance around the use of isolation and seclusion so it's disappointing that this guidance fails to address their use.

The guidance only applies in specific settings and doesn't cover mainstream schools and academies. In practice, some pupils with learning disabilities, autistic spectrum disorder or mental health problems who attend mainstream schools can have very similar needs to pupils in special schools, but there is no equivalent guidance for them. This has the potential creates a two tiered system of protections for children and young people, depending on which school they go to.

We think there has been a missed opportunity to set out legally binding guidance on the use of restraint for children and young people with mental health problems in all settings.

The Department for Education is currently consulting on whether they should draft similar guidance for mainstream settings and you read give them your views here.

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