Should our young people be experiencing physical restraint at any level?
Thursday 3 October 2019
David Grimm is a graphic facilitator, consultant, and a social work student. He is also a member of the Love work group and works as a 'Creative in Residence' for the Independent Care Review.
With Scotland currently undergoing a sector-wide review of care and promoting the idea of a loving environment and system for our young people, I ask:
Should our young people be experiencing physical restraint at any level?
Until recently my answer would have been that no person, let alone a child should ever experience physical restraint at the hands of an adult. Especially an adult in a paternal / guardian role of authority.
I am part of this group that has now got together to look at restraint, and I feel it is important to put forward my perspective in this debate, so I was delighted to be asked to contribute this blog post.
My reflections here are based upon my lived experiences, talking with friends, and recent discussions with professionals working in the care sector.
My lived experience of restraint
Throughout my time in residential care, I was never personally restrained. However, I witnessed friends being held to the ground and silenced in the name of 'personal safety' or the 'safety of others'.
At the time I believed this was okay - every young person in the residence thought this was normal, even if it wasn't a common occurrence. In hindsight, it was a rather unusual treatment that we just accepted as necessary. I can't explain why we thought this way, but we knew of other homes where this happened and the people enacting the holds, were – as far as I knew – paid, trusted members of staff who obviously knew better than us.
I believe the staff involved only used restraint in the most extreme circumstances, and only if they thought it was genuinely in our best interests, or necessary to keep us safe.
I once witnessed a 14-year-old girl, who trashed her room, worked up after her sibling contact had been cancelled as punishment for swearing, being restrained.
I heard and witnessed several causes for concern whilst in care, but this is one of my most vivid memories. Watching this was disturbing and caused me to question why I had never been 'pinned'?
I remember a few months after this incident that I found myself in the same situation, I was cheeky to staff which led to my sibling contact being cancelled, and me destroying my room. The noticeable difference was that police were called rather than any attempt being made to restrain me, and after minimal attempts to de-escalate my behaviour.
Police presence was another regular occurrence for us, but staff usually didn't call the police until all other routes were exhausted, including the usual last straw of restraint.
When I was told the police had been called, I slowly calmed down as I didn't want to add to my possible list of charges.
However, once the police had gone, I confronted staff and asked why it was that when others are angry you will restrain them, but with me you went straight to the police? And in the plainest voice, the reply was:
"Because you're too big and we would be in danger."
I remember feeling like the lowest version of myself because these people that I considered family(ish) had chosen to call the police rather than trying to hug me or treat me as equal to my peers by restraining me. The same staff who had once asked me to intervene and stop another young person from trying to stab them were now telling me they would rather criminalise me than try to hold me safe.
For weeks afterwards, I believed myself to be a real danger to those I lived with and that I was a criminal, worthy of police punishment. Also, that I was absolutely destined for jail.
At the risk of sounding dramatic, it took me almost 15 years to get over that sense of being a danger to others.
Listening to others
Over those last 15 years, I have discussed this at length with others who were restrained, and what sticks with me from those discussions is that three of these young people were thankful and loving to the staff for enacting the restraints. I asked one of them why they were thankful, and he said to me "it's better than being battered and jailed by the police mate". I remember thinking how sad it is that he felt that way, but at the same time how restraint clearly needed to be used on a case-by-case basis, and could strangely be used to show a sense of love/caring to the young person involved.
This was the first time I was exposed to thinking about restraint in this way and I've since re-evaluated my opinions. Recently my assumptions were again challenged when I listened to a presentation from a colleague at the SIRCC Conference, in which a person explained that they felt they needed to be restrained.
I then read an article about restraint which included examples of young people who challenged staff for not restraining them. The author wrote of a girl who shouts in his face as she wasn't restrained when she felt she needed it.
The author also argues that "The physical act of close holding is what is required" in relation to smaller children, but I would argue that we need this for adolescents too if we ever hope to minimise levels of restraint in care.
I am now understanding that it's not necessarily carried out in malice.
We need to work together
I don't think restraint is an issue that we will fix alone, we must work as a collective power to figure out what is best, but I think it's important to discuss that for some young people, restraint may help, whereas for others it doesn't.
It's important that the sector is able to adapt and be flexible to meet the needs of the individual child or young person.
There is no 'one size fits all' approach.
I do look forward to the future for care and embracing a loving, nurturing and caring environment for young people.
The views expressed in this blog post are those of the author/s and may not represent the views or opinions of CELCIS or our funders.
Commenting on the blog posts
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In my opinion restraining a child can almost always be avoided as it usually only serves to exacerbate an already tense situation. People get hurt when it is used and the child feels humiliated. Close holding seems like an entirely different thing.
Oct 3rd, 2019
Yes, Robert, close holding is potentially a different thing. So perhaps one way we could reduce the need for restraint is by providing close holding in other ways, so young people do not have to push to have this need met via restraint, but, as I asked in the article which David (flatteringly) refers to: "What if the young person really needs to be hugged closely for a long period of time? How many carers (and organisations) would be willing to do this?"
The article, for anyone interested, is here:
Amazing! Glad you wrote this needs to be spoke about and it’s a lot of the same views I have.
Oct 4th, 2019
Thanks for writing this article David. It's really important that the experiences and views of young people with care experience are heard-especially around this topic. I think there's a nice balance to the article, which captures the understandable unease which we all feel about restraint, but you also acknowledge some of the consequences which arise when children who are in obvious distress are not held.
I've been involved in a fair few restraints with kids over the years. It's never something that has ever sat easy with me, and I'm still plagued by doubt about whether it was always necessary or the right thing to have done: I often wonder what thoughts these children carry with them today about these events. Equally, there have been times where I haven't held a child in high states of distress and this sits perhaps more uncomfortably with me, as, in hindsight, I think the least harmful thing to have done would have been to have held them.
Thanks again for sharing your experiences.
Oct 4th, 2019
Thanks so much for your blog, David. While, like some of the other writing that’s being prompted by this action on physical restraint, it hurt to read it, I was also glad to have read it. What a mixture.
Sometimes discussions around restraint focus on the importance of carers trying to help a child calm down, and whether this is done well enough; your blog raises the parallel issue of things that should be avoided or that should simply not happen, and how some of these things can provoke the distress that can lead to the perception that restraint is needed. Sometimes it is a grey and difficult area, but in the case of denying family contact in order to punish, it’s not grey at all. This was considered an unacceptable thing when I was in direct practice in Scotland, which was during the same period you were in residential child care. I’m really sorry this happened to you (and to the other young person you wrote about). It shouldn’t have.
Oct 10th, 2019
Thank you all for your kind words and reflections, It has been brilliant to see so many people engaging with the discussion and blogs, also to see how many people have been comfortable to approach us and question us... Thank you all very much for this.
Oct 11th, 2019
The use of the word restraint is not something I like nor use. Safe hold is much more commonly used and it is, in my opinion from what I have been lucky to encounter a measure of last resort with the safety of the child and others at the forefront. I have never encountered a safe hold being used as punishment and only to prevent harm to the young person and others.
I have supported young people who are unable to regulate their emotions unless they are placed in a safe hold which has taken the place of a hug. I know personally, I have went to initiate a number of safe holds due to potential injury to others that have ended up in a hug - this however cannot always be guaranteed.
When supporting those with learning disabilities or developmental delay the support staff are not always able to judge the behaviour curve and the young person can be unable to learn other coping strategies and therefore this may become more of a concern for safe holds to become a maladaptive mechanism for regulation however, safety of the young person is paramount.
Under practice we understand that all behaviour is communication although it’s how we begin to unpick this and support the young person through, as residential and support workers we may hold the relationships although access to specialised services and intervention is limited. We need to ensure that we are not becoming “experts” and seeking appropriate advice, guidance and intervention.
Jan 19th, 2020
I was interested to hear that some children want to be restrained. I have found this with children with autism who become overwhelmed by sensory overload and go into a meltdown. They feel overwhelmed and out of control. This can be avoided by the right strategies and supports being put in place to elevate too much overload stimulus. This then reduces the anxiety and stress and restraints are not required. I would prefer the preventative option. Looked after children with autism are being restrained when it’s not necessary.