Patient Restrained for Extended Period at Mental Health Unit
An inspection has revealed that a patient in a mental health unit at University Hospital Wishaw was restrained by staff for approximately one hour.
This incident was among five cases identified by Healthcare Improvement Scotland (HIS) involving the use of prone restraint, a method where a patient is held face down.
Health guidelines recommend that restraint should not exceed 10 minutes, with prone restraint described as "inhuman and degrading".
The report also highlighted challenges related to privacy and dignity on the hospital's mixed-sex wards.
The Scottish government emphasized the need to address these issues promptly, referencing recent guidance from the Equalities and Human Rights Commission (EHRC) on single-sex spaces.
Concerns Raised Over Restraint Practices and Monitoring
Donna Maclean, HIS chief inspector, noted concerns regarding the use of prone restraint and the insufficient physical health monitoring during and after restraint episodes.
The National Institute for Healthcare and Clinical Excellence (NICE) advises that manual restraint should not routinely last longer than 10 minutes, and prone restraint should be minimized in duration.
The report stated:
"We observed five incident reports submitted as evidence detailing the use of prone restraint. The majority of these were to enable the administration of intramuscular medication due to stress and distress including violence and aggression. This included one incident where, although no patient harm was noted, it is documented that the restraint lasted for approximately one hour. However, it is not clear if the patient was restrained in the prone position for all of the duration."
Some cases lacked documentation specifying the duration of restraint.
The full inspection encompassed three mental health wards and an intensive psychiatric care unit, resulting in four areas of good practice, three recommendations, and 12 requirements.
'Mixed-Sex Accommodation Impacts Patient Dignity'
Maclean also observed inconsistencies in how seclusion—where a patient is isolated and prevented from leaving a room—was recorded by staff.
On some occasions, patients were confined to side rooms without this being documented as seclusion.
The inspection report noted that the three wards at the North Lanarkshire hospital are mixed-sex, which "can impact patient dignity and personal choice," although multibed bays are single sex.
It further stated:
"Curtains provide limited privacy, and the bays have windows to the outside corridor."
The report commended staff for their care and compassion, highlighting visible leadership on the wards and that younger staff felt well supported.
It added:
"The hospital environment, including communal areas, were clean and inspectors found that the majority of areas were well maintained."
Government and Hospital Responses
Mental wellbeing minister Maree Todd stated that NHS Lanarkshire must "urgently progress" the inspection's recommendations.
She said:
"While the report identifies good practice, we take very seriously the concerns around the issue of mixed-sex and mixed-function wards, the use of prone restraint, and the lack of physical health monitoring during and post restraint. The government is clear that the NHS must uphold the Supreme Court's judgment and adhere to the EHRC's new guidance on single-sex spaces. I expect (NHS) Lanarkshire to address this as a priority. Restraint must always be properly recorded, monitored and audited – used safely and only as a last resort."
Claire Rae, chief officer at University Health and Social Care North Lanarkshire, responded:
"We're pleased to see the good work of staff recognised in the report. Our staff work hard to provide safe, compassionate and person-centred care, and it's encouraging that their commitment and professionalism is acknowledged."
