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New NICE Guidance are a licence to kill

By Matilda MacAttram

The new government guidelines for the management of violent behaviour on mental health wards drawn up by National Institute for Clinical Excellence (NICE) have been slammed as profoundly inadequate and an appalling response to the Bennett Inquiry

David Rocky Bennett David 'Rocky' Bennett: Died in psychiatric care

The guidance, published yesterday will lead to more mental health patients dying because of the failure to introduce time limits on control and restraint. Health experts have described the new Guidance as a licence to kill.

The guidance comes six years after the death of Rocky Bennett in 1998, when his sister Dr Joanna Bennett began a campaign to uncover the truth about his death. She said ‘I am very disappointed that the guidance has not addressed the three minute rule for patient restraint which was key recommendation in the Rocky Bennett inquiry. The new guidelines allow healthcare practitioners to continue to restrain people without recognising that there are life threatening dangers associated with the procedure that they are using’.

David ‘Rocky’ Bennett died at the Norvic Clinic in Norwich in 1998 after five nurses held him face down for almost half an hour. The subsequent public inquiry into his death led to the Bennett Inquiry report that made widespread recommendations to improve the service and care for ethnic Black patients in psychiatric care services. This included a maximum three minute rule if ever a patient needed to be restrained.

Helen Shaw, co-director of Inquest, the campaigning group that supports families of those who have died in custody, has been a key supporter of the Bennett family. She told Blink ‘I am not convinced that this guidance will alert practitioners to dangerous practices that have led to deaths’.

quoteI am very disappointed that the guidance has not addressed the three minute rule for patient restraint which was key recommendation in the Rocky Bennett inquiry.unquote
Dr Joanna Bennett

Dr Bennett and those supporting calls for better treatment for Black patients have faced innumerable delays in the Government’s response to the Bennett Inquiry report. Earlier this year Health Minister Rosie Winterton promised that the recommendations ignored in the Governments response to the Bennett Inquiry would be incorporated into the NICE guidelines.

‘The Government indicated that the NICE guidelines would respond to a number the recommendations around control and restraint but there has been no mention of it in the NICE reference guide or the full document. Even at the launch this week there just wasn’t any mention of the Inquiry and how NICE has responded to those recommendations.’ Dr Bennett pointed out.

NICE’s decision to ignore the advice of the Bennett Inquiry panel, Inquest and other organisation who with any critical or practical experience in deaths in custody is seen as the reason why the guidance is so out of touch with what is actually needed. ‘It is clear from this that they have not read the evidence that was given to them by the Inquiry from pathologists, practitioners and psychiatrists who have conclusively agree that restraining someone face down is really dangerous.’ Helen Shaw added

Martin Dougherty, director of the National Collaboration Centre for Nursing and Supporting Care (NCC), was responsible for drawing up the guidelines. He told Blink that all groups concerned were consulted but could not explain why there was not one Black professional on the Guidance Group that drew up the report. ‘This is not enough to protect patients and staff, NICE have not listened to the people who have the most direct concern or experience on physical intervention. There is no mention of prone restraint in the guidance and that it has actually led to death. How will staff picking up the quick reference guide be alerted to the fact that there is potential danger to prone restraint, that it is a matter of life and death.’ Dr Bennett pointed out.

The all-White team of clinicians appointed to drawing up the NICE Guidance on control and restraint, a practice that disproportionately effects African Caribbean flies in the face of the Governments commitment to diversity and patient involvement.

quoteI am not convinced that this guidance will alert practitioners to dangerous practices that have led to deaths.unquote
Helen Shaw, co-director of Inquest

‘Given that people of African Caribbean people are more likely to be sectioned, injected and considered dangerous it is always surprising that when people are producing guidelines that are going to disproportionately effect this group of people that you don’t always collect the right expertise onto these panels,’ leading Black psychiatrist Dr Kwame Mckenzie said. ‘The fact that this has come out of the Department of Health and they talk about user involvement and stakeholder involvement is disappointing and needs to be a lot better organised’ he added.

Many agree that the time and money spent on these Guidelines really add nothing new to existing guidance on control and restraint within and the mental health act code of practices. ‘Nothing new has been included and the guidance hasn’t made any links with the recommendation from the joint commission for Human Rights report which actually recommends that there should be some guidance with a time limit on the use of prone restraint.’ Dr Bennett said.

‘Positional asphyxia was a term that the nurses responsible for the death of David Bennett had never heard of. The NICE guidance group has missed a golden opportunity to provide practitioners with information and a framework for improving their practice that will in fact save lives.’

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