Reducing the indignity of physical restraint

Pineapple Contracts has recently unveiled two pieces of furniture designed to make physical intervention practices in the mental healthcare sector safer and more dignified for patients, as well as staff. Daniel White, the company’s head of Sales, explains how the products were developed, and the rationale behind them.

Identifying a lack of purpose-designed products, we at Pineapple Contracts worked closely with Andy Johnston, an experienced independent mental health consultant, to ensure that every angle of the JAK De-escalation couch was carefully considered to enable respectful methods of restraint while providing invaluable support for staff. Ellern Mede Specialist Eating Disorder Services, which is widely regarded as the UK’s most specialist provider of intensive inpatient and outpatient treatment for children, adolescents, and young adults, was consulted during the design of a version of the couch aimed at making the challenging, but sometimes unavoidable, process of naso-gastric intubation safer, and minimising the counter-therapeutic impact of the procedure.

Andy Johnston is a former clinical director in mental healthcare, and an independent mental health consultant, with over 32 years’ experience in mental health services, including in conflict resolution and physical intervention. His team of mental health professionals collaborated in designing the JAK De- escalation couch, and tested prototypes throughout the design process, using role-play scenarios to test the ergonomic design over extended periods of high-

intensity restraint. With the help, expertise, and input of Ellern Mede Specialist Eating Disorder Services, the NG-feeding couch was developed to provide a safe and stable environment for patients undergoing naso-gastric intubation.

Physical restraint

The Department of Health & Social Care defines physical restraint as ‘any direct physical contact where the intention of the person intervening is to prevent, restrict, or subdue, movement of the body, or part of the body, of another person’. While care providers will always aim to minimise disruptive behaviour using verbal de- escalation, this approach may not always be successful. When a patient is in severe distress, and initial verbal de-escalation techniques have proven ineffective, physical restraint may be used as a last resort to prevent the patient causing harm to themselves and others. Between 2016 and 2017, data collected from 40 mental health Trusts in England identified 59,808 uses of restraint.1 Examples of physical restraint can range from low-level intervention (e.g. in a standing position with one staff member) to severely restrictive techniques like prone restraint (a controversial ‘face-down’ technique which is associated with risks of positional

Daniel White, head of Sales at Pineapple.

asphyxiation, the use of which NHS guidelines now advise against). Between the two extremes, there are a number of techniques which can be applied depending on the circumstances, and healthcare professionals will always seek to use the least restrictive practices in the first instance.

Use of mechanical restraint In some cases, devices such as belts or cuffs are employed to control a person’s freedom of movement. While such devices reduce the physical demands on staff, this form of restraint – known as mechanical restraint – is considered to be the most restrictive form of intervention, and should only be used in exceptional circumstances. Compared with sensitively applied physical restraint techniques, mechanical restraint is generally less flexible to the needs of individual patients, and can carry a greater risk of counter-therapeutic effects.

‘Every angle’ of the JAK De-escalation couch was

‘carefully considered to enable respectful methods of restraint, while providing invaluable support for staff’.


Impact on patients and staff Although physical restraint is used to keep patients safe, it can nonetheless be a disturbing and disempowering experience which may negatively impact their treatment. For those who have previously suffered physical abuse, the negative impact may be even more severe. Opportunities to minimise the counter- therapeutic impact should be explored


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