Editorial
| DOI | https://doi.org/10.1108/14668203200100008 |
| Pages | 2-7 |
| Date | 01 May 2001 |
| Published date | 01 May 2001 |
| Author | Bridget Penhale,Hilary Brown |
| Subject Matter | Health & social care,Sociology |
2© Pavilion Publishing (Brighton) Limited The Journal of Adult Protection Volume 3 Issue 2 • May 2001
Editorial
The papers in this edition focus on the issues
raised by what was previously known as
‘control and restraint’. Interventions covered
by this label include a broad range of physi-
cal, pharmacological and technological
strategies for preventing and/or dealing with
challenging behaviour, self-injury, wandering,
falling and other situations that are perceived
to create risks to, and for, vulnerable individ-
uals. These strategies often involve the use of
force and/or potential breaches of the person’s
human rights, even if these seem to be being
subordinated for good reason.
But ‘control and restraint’ may also provide
a rationale and cover for intimidation,
impatience and cruelty. Techniques may be
used to short-circuit positive planning and
decision-making, as, for example, when
service users are sedated to make them
compliant, or when cot-sides or low chairs
are used to keep service users in one place for
long periods and to lessen pressure on staff
time. There is a risk that practice becomes
‘defensive’ and geared too much towards
protective measures and not enough towards
empowerment and informed choice.
Sometimes such techniques are used to
punish or to ‘teach’ the person a ‘lesson’ even
if these rationales are hidden beneath the
surface or obscured by jargon.
The interventions which cause most
concern necessarily take place at the ‘sharp
end’ of practice and tend to be implemented
by hard-pressed staff in crisis situations. But
once accepted for use in emergencies such
interventions may creep into everyday
practice and obscure the need for positive
approaches designed to ameliorate the diffi-
culties in communication, difficult behaviour
or involving service users, which can lead to
distress or disruption. Moreover, once accept-
ed for use in relation to specific situations or
particular individuals, these strategies may
‘take over’ and become the intervention of
first choice rather than the last resort.
Some of the technologies seem more user-
friendly but still infringe basic rights and
freedoms. Marshall (1997) goes so far as to
suggest that many of the actual technologies
(including medication) are ‘value- free’ and
that ‘it is the way that it is used which can
raise concerns’, adding: ‘Even relaxation
equipment can be used to stupefy rather than
to benefit residents’ (p7).
A slippery slope?
There is considerable evidence for this ‘slide’
into indiscriminate application and routine
contravention of positive practice. For
example, Paul Cambridge (1999) documented
an inquiry into practices at a service for two
men with learning disabilities and challenging
behaviour. Within this service new staff were
inducted into a regime in which they were
told that ‘it was the first hit that mattered’.
The recent McIntyre Undercover television
documentary demonstrated how inappropri-
ate restraint techniques came to dominate
practice in a large independent home for
people with learning disabilities.
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