Sheffield MP says rising number of children with eating disorders being restrained on hospital wards
It's often done by staff who are not trained in how to do it safely
Last updated 6th Sep 2023
We're investigating the use of restraint on eating disorder patients as a Sheffield MP tells us the government has backtracked on a promise to look into the issue.
Guidance from the Department of Health says it should be used as a last resort and only in life-threatening situations.
But some experts and campaigners are concerned its use is becoming more widespread as a growing number of eating disorder patients are admitted to general hospital wards rather than specialist mental health beds.
There, they may be restrained by staff who are not trained in how to do it safely – and crucially, its use doesn’t have to be recorded in the way that it would if it were done in a mental health setting.
ELLIE’S STORY
Ellie, 25, was diagnosed with anorexia when she was 13 and has been restrained both in specialist eating disorder units (SEDUs) and on a general hospital ward.
She spent around seven weeks on the hospital ward where she says she was restrained twice a day by security guards wearing body armour so that she could be fed via a tube:
“Imagine four grown men, all with heavy vests on, quite literally lying on top of you with their whole body weight, doing anything they can to stop you from moving… whether that be causing you physical pain or not, it seemed like they didn’t care.
“I have pictures of bruises that were left, friction burns. I’m honestly surprised I didn’t break a bone.
“Afterwards I would feel physically exhausted, like I’d just run a marathon. There were a couple of times when the ‘nicer’ security guards said it was too dangerous to do the restraint and they would stop. But this happened literally a couple of times. Most of the time they didn’t care.”
She says she was left ‘traumatised’ by the experience and terrified of being restrained in the SEDU she’s now being treated at, even though she knows the staff there are properly trained in how to do it.
“She sent a photograph of her neck which had handprints on it where they tried to restrain her, her arms with handprints on,” says Ellie’s mum Nikki.
“I remember one day where I’d gone to visit her and they’d just turned up to feed her, and I saw three security guards in body armour going into her room. So I said I’ll wait in the parents’ room. And the screams… I’ve never heard anything like it, it was just horrendous. Because you know they’re hurting your daughter.”
Both Ellie and Nikki acknowledge that restraint and nasogastric feeding are sometimes necessary to keep somebody alive, but they say if it does need to happen it should only be carried out by people who are fully trained.
“These security guards, essentially bouncers, had no idea what to do apart from suffocate me under their body weight,” says Ellie.
“No patient should be injured physically.
“I also think support after what is a very traumatic event should be offered. The majority of times after my feeds, the security and nurses would just leave me and I wasn’t offered any kind of support. Sometimes I just needed a hug or a chat, but I was just left to cry.
Nikki says hospital staff in general often lack awareness of how to deal with eating disorder patients:
“It’s a very fine balance when you’re dealing with eating disorder patients.
“(On one ward), the nurse used to bring her in a menu card and say ‘tick what you’d like for lunch’, you know, ‘would you like bacon, sausage and eggs?’
“It’s just lack of training. And I think it depends on the consultant’s knowledge, understanding and want to know of eating disorders.”
OLIVIA BLAKE’S CAMPAIGN
Restraint in a mental health setting is regulated by the Mental Health Units (Use of Force) Act 2018, which requires staff to record each use of restraint.
But the act only applies to patients being treated in a mental health unit – which means when eating disorder patients are treated on a general hospital ward, the use of restraint does not have to be recorded.
Without any data, it’s impossible to know how widespread the issue is.
Sheffield Hallam’s Labour MP Olivia Blake raised this during a debate in Parliament in February.
Maria Caulfield, the minister responsible for mental health, said she would look at potential “loopholes” in the legislation.
But Olivia says the minister has since written to her confirming there is ‘no plan’ to change the legislation.
Olivia, who sits on the All Party Parliamentary Group for Eating Disorders, says she has spoken to numerous specialists, researchers and medical staff who have raised concerns about the rising number of children with eating disorders being restrained by untrained staff in general medical wards.
She said: “The Department of Health guidance clearly states that restraint by medical professionals should only be used in life-threatening situations and should be minimised across all adult health and social care settings.
“But currently we have no way of knowing whether this is happening routinely in general medical settings, because health professionals are not required to record or monitor its use.”
She has teamed up with prominent eating disorders campaigner Hope Virgo, who told us about some of the troubling firsthand experiences she’s heard from patients:
“It’s affecting people as young as eight, nine years old.
“I’ve had people send me photos showing bruising all over their arms, all over their legs.
“I heard recently from a young girl who was restrained at about 10.30pm at night because the hospital staff decided she needed to have an extra feed that evening. And she wasn’t aware it was going to happen, so coming into her bedroom…it was really shocking.
“That will then mean for her, every single evening she will potentially have this fear that ‘what if that’s going to happen again?’
“It means they’re not going to comply with the programme which means they get discharged out into the community and they’re just marked as ‘untreatable’ and discarded at the wayside.”
The most recent data from the NHS shows an 84 per cent increase in UK hospital admissions for eating disorders in 2021-2022 compared to five years earlier.
This includes a 79 per cent increase among adults, many of whom are admitted to general medical wards that don't have input from expert eating disorder services.
Olivia Blake has asked the minister to meet with her and Hope to discuss the issue further.
What is the government doing?
The Department of Health says while it has no current plans to amend the Mental Health Units Act, it does acknowledge the issues raised and is looking into them further.
It says the NHSE’s Restrictive Practice Oversight Group (RPOG) is working on reducing the use of restraint in mental health inpatient settings. The RPOG also published recent guidance on paediatric restrictive practices and nasogastric feeding which encourages clinicians to consider restraint as a last resort.
It adds that all NHS commissioned providers must make sure relevant staff have received training in restrictive practices that complies with the Restraint Reduction Network (RRN) Training Standards.
It says the government is investing almost £1 billion in community mental health care for adults with severe mental illness, including eating disorders, by 2024.