Decision report 201100984

Summary

Mr A had a history of contact with psychiatric services since he was a teenager and had received a range of diagnoses. Mr A's mother (Mrs C) complained that a staff member in the hospital's rehabilitation unit verbally abused him and restrained him inappropriately and, when Mrs C reported this to a senior person, it was ignored.

We did not uphold Mrs C's complaint. We looked at her account of what happened and compared it with the hospital's records, and found that there was a discrepancy in the dates of when the alleged verbal abuse and restraint took place. Because of this, it was not clear whether the board investigated the incident Mrs C referred to in her complaint. We asked our mental health adviser to review all the recorded incidents throughout Mr A's admission. We were satisfied there was only one recorded episode of physical restraint being used, which took place on a different date from the alleged incident Mrs C referred to.

We found nothing in the clinical records to suggest that the amount of force used in the recorded incident was excessive. However, we accepted what our adviser said about a lack of documented detail of the restraining techniques used. We were, however, generally satisfied that Mrs C's concerns were taken seriously and investigated promptly. The investigation which was carried out appears to have been as thorough as it could have been with the evidence available. The lack of detail in the records reflects the guidance available to staff about restraint techniques and the recording of incidents of aggression from patients. We noted that, had the incident been recorded in further detail, it might have been possible for us to comment more constructively on the appropriateness of the restraint techniques used.

Recommendations

We recommended that the board:

• considers creating a specific restraint policy, detailing the techniques that can be used and the information that should be recorded in the clinical records.