Coroners, courts, regulators and inspectors have recorded what restraint does to the people it is used on. This casebook publishes those records as short, sourced case pages: what happened, what went wrong, and what it means for the people running the service.
Every entry states its confidence, what could not be verified, and where the source runs out. Where a case is still live, we hold it. Where a name cannot be justified, we do not print it. Publications are labelled as publications, because a national count is not an incident.
147 case entries and 47 publications.
Taken out of the road, then a cardiac arrest in hospital
A man who was running into traffic was restrained and arrested, then stopped breathing during a hospital examination. He survived, and the regulator found no fault in the…
Tasered for 33 seconds, then kicked in the head
A former footballer in a psychotic state was Tasered three times and kicked in the head as he lay on the ground. One officer was convicted of manslaughter.
The hospital was five minutes away
A 25-year-old law student suspected of holding drugs in his mouth was driven to a police station instead, and died the same evening.
Twenty minutes face down, then a day in a body belt
A 29-year-old prisoner was held prone on a landing and then belted for twenty-four hours. The inquest heard he would not have died but for the restraint.
A six-year-old tied to a chair, and nobody called it restraint
A learning support worker tied a non-verbal six-year-old to an adult chair and left the room. A fitness-to-practice panel gave her a reprimand.
PublicationAn inspection regime that saw a decade of abuse and did not act
The 1998 independent inquiry into two Buckinghamshire care homes found that the council's inspectors watched evidence of abuse accumulate and never used the sanction they held, withdrawal of…
Face down with his hands cuffed behind his back
Kenneth Severin, 25 and psychotic, was restrained at HMP Belmarsh and carried to a strip cell. The inquest found positional asphyxia.
Restrained in psychosis, then left unmonitored in seclusion
Restrained during acute post-partum psychosis, then secluded with her vital signs poorly monitored, a woman died of a cardiac arrest answered too late.
Tasered and batoned in a hostel toilet, dead nine days later
A 32-year-old electrician in acute behavioural disturbance was Tasered, sprayed and restrained at a probation hostel, and died of multi-organ failure nine days later.
PublicationThirty-eight restraints in one trust, more than 3,000 in another
Mind asked every mental health trust in England how it used physical restraint. According to its report, the range ran from 38 incidents in one trust to more…
A doorman’s hold broke a clubber’s neck on a night out
A 22-year-old was restrained from behind at a Southampton nightclub and left paralysed. The doorman was convicted of grievous bodily harm.
A headlock used to remove a customer broke her neck
Joanne Piednoir was 44 and on a night out in Windsor when a door supervisor put her in a neck hold during her ejection.
A lap belt was fitted to her wheelchair and left undone
A 99-year-old resident fell from a stationary wheelchair and died five days later. The coroner's concern was larger than the belt.
A woman with dementia was tied to her bed rails with a sheet overnight
A registered nurse tied a bed sheet across a resident's chest and to both rails so that she could not turn. The nursing regulator imposed no sanction.
An hour on the ground after a call logged as an overdose
A 35-year-old in acute behavioural disturbance was held on the ground for almost an hour, after the call for an ambulance was logged as a drug overdose and…
Died alone in seclusion, far from home
An inquest found that seclusion and long-term segregation contributed to her decline, and that staffing levels probably contributed to her death.
Found dead beside her bed with the sensor switched off
A 91-year-old woman with Alzheimer's disease died at a nursing home where the bed-rail policy was never put into practice.
Left with one worker on top of him
A 38-year-old man died of a cardiac arrest during a restraint in his room, on a unit that had changed technique without rehearsal.
More than three hundred restraints and a school rated inadequate
A boy with autism and Down's syndrome was restrained hundreds of times in two and a half years at a private residential special school. The claim settled out…
PublicationMost councils could not count the restraints in their own schools
A BBC Radio 5 live FOI survey of special schools found 13,000 recorded restraints of children over three years, and 731 injuries, per the returns it received. Fewer…
PublicationThe investigation that counted what families said about restraint
An independent inquiry into a Welsh dementia ward found that medication and restraint were used to manage behaviour, and recorded what 23 families described.
PublicationThe regulator that found no national restraint figure for schools
A statutory inquiry by the Equality and Human Rights Commission concluded that nobody in England or Wales could say how often schools restrain children, because nobody had gathered…
PublicationThe response that promised to close the wards
The Department of Health's answer to the Winterbourne View exposure set out a closure programme for inpatient units. It is a statement of intent, not a finding about…
PublicationThe review that found restraint routine on many wards
The 2018 review of the Mental Health Act found restraint was still routine on many inpatient wards, fell hardest on some groups, and was so inconsistently counted that…
PublicationThe review that found restraint was the visible edge of abuse
A safeguarding review of a private hospital for adults with learning disabilities found that restraint there was not a technique going wrong. It was the routine expression of…
Thirty minutes face down after the fight was over
A remand prisoner who had just had an epileptic fit was restrained face down for half an hour, and died in a healthcare cell.
Thirty-three minutes face down, saying he could not breathe
A man in a psychotic relapse was restrained face down for 33 minutes; the jury found the restraint contributed to his death.
Told to spit it out while he stopped moving
A 20-year-old man restrained on a shop floor was told to spit out what was in his mouth; the jury found the force justified and the response to…
A boy died at a school with no policy for the hours after restraint
An inquest found a residential school failed to assess a 15-year-old's suicide risk, and had no adequate policy for what happens after a child is restrained.
A children’s home that restrained often, where children stopped complaining
An inspection of a Welsh local-authority children's home found restraint was frequent, staff were uneasy about how often they used it, and some children had stopped believing complaint…