The shoulder: taking the strain during restraint.

The decision to use or utilize physical intervention techniques is a contentious one. There has been much discussion on the complex legal and ethical dimensions framing the use of force. The risk of injury has also been considered in detail, but almost all of the published work has focused on restraint asphyxia, the prone restraint hold and the use of particular pain compliance techniques such as the wrist flexion hold. This paper focuses on the structure and function of the shoulder and examines how physical interventions and a variety of risk factors can threaten its physical integrity. This paper is for practitioners such as training commissioners, trainers, frontline staff and investigators or regulators who have to make considered determinations on the potential immediate physical impact of a variety of holds and escape manoeuvres. Sound risk assessment must be premised on a sound understanding of anatomy and physiology.

Proposing a common sense approach to assessing the risks posed by physical intervention techniques.

Irrespective of whether they are universally accepted or approved, physical intervention techniques are being applied, in a variety of health and care settings, on a daily basis. Every time a technique is applied there is a risk of injury. Therefore, there is an imperative to develop an effective way in which such techniques can be effectively risk assessed. The development of a process that is robust enough to evaluate all types of techniques, and is simple and concise enough to engender widespread and regular use could eliminate the use of unnecessary and inappropriate techniques. This paper discusses how the five-step model proposed in the UK by the Health & Safety Executive as well as a common sense approach to completing assessments could be used to simplify the process.

Physical intervention trainers: the case for greater accountability.

Physical intervention training courses are commonplace events in psychiatric and mental healthcare settings across the UK. While there is still debate as to what techniques should be taught on such courses, there is good evidence as to the mechanisms whereby pain, injury and even death can be inflicted. There is also a wealth of literature identifying how organizational culture can influence the quality of service delivery and standards of client care. It is well documented that the dignity, well-being and physical integrity of service users can be compromised by staff acts and omissions stemming from corrupted cultures. What has not been explored in detail to date is the role of physical intervention trainer, specifically the values they model and how these may influence the readiness with which staff resort to physical restraint strategies. It is possible that even approved physical techniques can become compromised through poor training technique and expose end recipients to needless humiliation and potential harm. This paper discusses this area of practice, offers insight on how the learning process is compromised by trainers and suggests areas for future research.