Millfields Charter - Criticism

Criticism

The charter has stimulated a debate in the UK. McDonnell (2007) in a debate article, highlighted the arguments in favour of the Charter. McDonnell focussed on the limitations of restraint usage and the lack of effectiveness data. He maintained that staff training programmes which focus on restraint are a by product of a fear industry which often depicts staff training as a solution to the problem. Restricting the teaching of physical interventions and the banning of prone methods was proposed as a way forward. He argued that a ‘paradigm shift’ is required in the training industry to change the attitude to behaviour management training. Paterson (2007), while supporting the motives of the Charter signatories, disagreed with the impact of their proposals. He argued that there are a variety of prone holds, some of which use more force than others. He also argues that the scientific evidence for the relative effectiveness of specific restraint methods is limited and therefore banning prone holds would constitute a large scale uncontrolled experiment.

Research on the effects of restraint position does not support the view that prone (face down) restraint has harmful effects. Measurement of lung function in various restraint positions has demonstrated that restraint face down in a flat position, with no weight applied by restraining persons, has no significant effect on breathing.

Leadbetter (2007), presented a balanced response to the first two authors (McDonnell, 2007; Paterson, 2007). Leadbetter (2007) applauded both authors for encouraging debate on this topic. With regard to the issue of prone restraint he argued that ‘we are well beyond any creditable debate that restraint in the prone position is safe’. However, he stopped short of agreeing to a generalised ban arguing that sectors such as mental health may require the limited use of such methods, whereas intellectual disability services might achieve such a goal.

In conclusion, encouraging debate would appear to be an important focus of the Millfields Charter. A focus on prevention of restraint usage, the restricted use of methods such as prone holds and the encouragement of a clear moral framework for the use of such methods. The Charter obviously has proponents and opponents who are equally passionate about their views. The debate about restricting behaviour management practices is obviously wider than the issue of one class of restraint methods. The Charter appears to have stimulated a useful and important debate.