A small number of mental health patients have died suddenly following violent behaviour and restraint by staff. The safety of certain restraint positions has been questioned. This study evaluates two control and restraint (C & R) positions commonly used by health service staff. A repeated measures design was used to study rate of recovery from exercise in volunteer staff, measured by pulse oximetry, comparing the restraint positions with a seated (control) position. It was found that the recovery time for pulse rate of subjects restrained in a face-down position was significantly longer than for subjects restrained in a face-up position. No significant findings were made in terms of comparison between the control position and the restraint positions, and no significant changes in oxygen saturation were noted during restraint. It is concluded that restraint position may be a factor in death during restraint, but only where other factors contribute to the overall situation.

Small but significant numbers of people die during restraint following violent incidents. Current guidance within the NHS states that all restraint positions should be considered to present equal risk. We used a repeated measures design to compare lung function in four restraint positions with a standing control position. Participants restrained flat on the floor, prone or supine, showed non-significant reductions in forced vital capacity (FVC) and forced expiratory volume FEV1 compared with the standing control position. Participants restrained face down with the body weight of the restraining persons pressed on their upper torso and/or in a flexed restraint position showed a significant reduction in lung function (mean reductions in FVC of 23.8% and 27.4% respectively). Recommendations that all restraint positions pose equal risk, or that all prone restraint is dangerous, are not supported by these findings. Some, but not all, prone restraint positions show significant restriction of lung function.

The study describes and analyses incident reports over a three-year period in a medium secure unit. A low threshold of reporting was encouraged and substantial numbers of 'minor' incidents were reported. The frequency of incidents peaked in the evenings. The use of seclusion and manual restraint is reported and these were used more frequently where staff were the target of aggression.

Seated restraint positions with the person leant forward may increase the risk of harm or death during prolonged restraint. The risk will be further increased where the person exhibits higher BMI.