Research & reports

Prison’s behaviour management and restraint of children in custody: A thematic review

The aim of this thematic report was to explore the implementation of the new system of behaviour management and restraint in young offender institutes (YOIs) and secure training centres (STCs). An approach known as ‘minimising and managing physical restraint (MMPR) was introduced to de-escalate volatile incidents and reduce the number of children who experience restraint. Its introduction followed the deaths of two boys in 2004. Gareth Myatt became unconscious during a restraint after an officer informed him ‘If you can talk, you can breathe’, which was not the case. Adam Rickwood, aged 14, hung himself after he was subjected to a ‘nose distraction technique’, which was a painful jab under the base of the nose. Supporting MMPR a comprehensive system of national governance and oversight was introduced to not only improve this method but to adhere and promote safe practice within YOIs and STCs.

To inform the report six establishments were visited, which involved speaking with children who had experienced restraint and interviewing staff who applied it. In addition, group discussions were held with senior managers and MMPR co-ordinators responsible for the training and monitoring at local level. Additional research included reviewing documents, behavioural management plans and viewing CCTV of incidents.

The key findings were that whilst believed it is sometimes necessary to restrain children as a safety measure, there is no such thing as a completely safe restraint. This is supported by children continuing to suffer restraint-related injuries in those establishments implementing MMPR. However, it was recognized that the principles behind MMPR are an improvement on previous different and limited systems used. Additionally it was found that staff shortages and cultural issues across some parts of the juvenile estate have delayed the implementation of MMPR, which have restricted the development of good practice. Cultural change was attributed to ineffective relationships between staff and children particularly in YOIs, which are larger establishments. STCs, on the other hand, reported more positive relationships due to staff having the time. Seventy per cent of children in YOIs reported being treated with respect whilst 93 per cent identified respectful behaviour in STCs. However, children were unable to pinpoint any differences between the implementation of MMPR and previous behavioural management systems. From many accounts it remained a distressing and painful experience with varied reports from children of the de-escalation process. It was recorded that some staff would communicate to the child throughout the process and attempt to calm them whilst little effort was made by others. CCTV footage revealed poor de-escalation by staff and MMPR being instigated in minor incidents.

It was found that all establishments had implemented behavioural management plans for those children with more challenging behaviour. Yet, the plans were not always clear and the review team held the view that not all children who required a plan had one. Moreover, the plans viewed were of a poor standard with an inadequate assessment, no relevant targets or the plans lacked a review of the child’s progress. This failed to enable staff to manage those children expertly. Worryingly the inspection identified ‘potentially dangerous’ evidence of staff not adhering to plans particularly in relation to children with medical needs or other conditions who would be affected by MMPR.

Particular concern is given by the review to the restraining of children on the floor along with the application of head holds and the use of pain-inducing techniques. Despite MMPR not allowing staff to take children during restraint to the floor intentionally because of the potential medical risks, findings revealed otherwise. Nearly half of all the incidents ended with children on the floor (70% in YOIs) and there were misapplication of the head hold, resulting in a number of medical referrals. Disturbingly, unacceptable examples were found of children being strip searched under restraint in YOIs. Despite policy citing that pain should only be used as a last resort to avoid immediate risk of physical harm, it was found pain-inducing techniques were used frequently in YOIs and therefore staff were not compliant with the requirement. It was noted that staff in STCs did not use these techniques. There also appeared to be an under-reporting of these techniques in YOIs and no evidence was found to justify the ‘deliberate infliction of pain as an approved technique’ (p. 6).

Findings further revealed some establishments failed to call MMPR health care staff to all incidents and in some cases, a physical examination of a child after restraint was not undertaken. Additionally, the children interviewed reported that staff failed to speak to them after an incident to check their well-being. Subsequently post-restraint debriefs with children did not take place and if they did, they varied in quality.

Overall, findings revealed there were poor recordings of incidents and under-reporting of pain-induced techniques, inadequate quality assurance and unreliable referrals impacted upon the improved oversight at national level. It was found this was more problematic in the YOIs. While the purpose of CCTV is to provide evidence, it was found it did not cover all incidents and if it did, it was not reviewed for a significant period of time. Body worn cameras are a recommendation to overcome this.

The review made ten recommendations, including:

The findings should inform the Youth Justice Review and all efforts should be made to ensure structure, culture and staff of the juvenile estate to assist staff in managing challenging behaviour efficiently and effectively and de-escalate incidents of the use of force.

While the use of restraint is seen as necessary with certain challenging behaviour from children in secure establishments, it seems cultural change and adherence to good practice are essential for it to be safe. This report is disturbing and offers an insight to the harm and, at times, the lack of dignity attached to being restrained. The statements of children are a reminder of the fear that can be felt when exposed to being restrained by adults particularly if guidelines are not followed.

Thematic Report by HM Inspectorate of Prisons. Behaviour Management and Restraint of Children in Custody. A Review of the Early Implementation of MMPR by HM Inspectorate of Prisons, November 2015. Available for download at https://www.justiceinspectorates.gov.uk/hmiprisons