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Nick Hardwick HM Chief Inspector of Prisons EPSO European Partnership for Supervisory Organisations in Health and Social Care Brussels, April 18-19 2013 INSPECTING THE USE OF FORCE AND RESTRAINT IN SECURE ACCOMMODATION

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Nick Hardwick HM Chief Inspector of Prisons. Inspecting the use of force and restraint. HM Inspectorate of Prisons OPCAT and the UK National Preventative mechanism Why independent inspection is necessary Use of force and restraint in social care settings Inspection principles. - PowerPoint PPT Presentation

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Page 1: Nick Hardwick HM Chief Inspector of Prisons

Nick HardwickHM Chief Inspector of Prisons

EPSO European Partnership for Supervisory Organisations in Health and Social CareBrussels, April 18-19 2013

INSPECTING THE USE OF FORCE AND RESTRAINT IN SECURE ACCOMMODATION

Page 2: Nick Hardwick HM Chief Inspector of Prisons

www.justice.gov.uk/about/hmi-prisons2 www.justice.gov.uk/about/hmi-prisons

Inspecting the use of force and restraint

HM Inspectorate of Prisons OPCAT and the UK National Preventative

mechanism Why independent inspection is necessary Use of force and restraint in social care

settings Inspection principles

Page 3: Nick Hardwick HM Chief Inspector of Prisons

www.justice.gov.uk/about/hmi-prisons3

About HM Inspectorate of Prisons

Independent, human rights based with the experience of the detainee at the heart of our work

A long history – dating back to C18 Role: To report on the treatment of prisoners

and the conditions in prisons Remit: prisons, youth custody, police and

courts custody, immigration detention, military custody

Page 4: Nick Hardwick HM Chief Inspector of Prisons

www.justice.gov.uk/about/hmi-prisons4 www.justice.gov.uk/about/hmi-prisons

OPCAT (1)

‘Optional Protocol to the UN Convention Against Torture and other cruel, inhuman or degrading treatment or punishment’ – 2002

Some overlap with the Council of Europe Committee for the Prevention of Torture (CPT)

OPCAT requires an independent ‘National Preventative Mechanism’

NOT a regulator, auditor or complaints handler Adequately resourced with diverse and expert

personnel

Page 5: Nick Hardwick HM Chief Inspector of Prisons

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OPCAT (2)

Regular independent inspection of all places where people are detained

Freedom to choose where and when to go Complete access and opportunity for private

interviews Access to information Public reporting Make recommendations and free to comment on

legislation

Page 6: Nick Hardwick HM Chief Inspector of Prisons

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The UK NPM (1)

OPCAT ratified 2003 NPM established 2009 18 existing bodies inspecting or monitoring criminal

justice, immigration, health/social care and children England, Scotland, Wales and Northern Ireland Co-ordinated by HMI Prisons http://www.justice.gov.uk/about/hmi-prisons/

preventive-mechanism

Page 7: Nick Hardwick HM Chief Inspector of Prisons

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The UK NPM (2) ENGLAND AND WALES

• HMI Prisons• Independent Monitoring Boards• Independent Custody Visitors• HMI Constabulary• Care Quality Commission• Office for the Children’s Commissioner for England• Office for Standards in Education, Children’s Services and Skills• Care and Social Services Inspectorate Wales• Healthcare Inspectorate Wales

SCOTLAND• HMI Prisons for Scotland• HMI Constabulary for Scotland• Scottish Human Rights Commission• Mental Welfare Commission for Scotland• Care Inspectorate

NORTHERN IRELAND• Independent Monitoring Boards• Criminal Justice Inspectorate• Regulation and Quality Improvement Agency• Independent Custody Visitors

Page 8: Nick Hardwick HM Chief Inspector of Prisons

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OPCAT in Europe

NPM ESTABLISHED Albania Armenia Austria Croatia Cyprus Czech Republic Denmark Estonia France Germany Hungary Liechtenstein Luxembourg Macedonia, FRY Malta Moldova Montenegro Netherlands Poland

Serbia Slovenia Spain Sweden (NPM established) Switzerland UkraineOPCAT RATIFIED, NPM TO BE DESIGNATED Bosnia and Herzegovina Bulgaria Georgia Italy PortugalOPCAT STILL TO BE RATIFIED Belgium Finland (treaty still to be ratified) Greece Iceland Ireland Norway (treaty still to be ratified) Romania Turkey

Page 9: Nick Hardwick HM Chief Inspector of Prisons

www.justice.gov.uk/about/hmi-prisons9 www.justice.gov.uk/about/hmi-prisons

Why independent inspection is necessary?

The power imbalance between the detainee and custodian

The closed nature of the institution and the supposed lack of credibility of the detainee

The normative effects of custody The ‘virtual prison' Low morale and poor training of staff

Page 10: Nick Hardwick HM Chief Inspector of Prisons

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What is detention?

Prisons, police cells etc People with dementia in a care facility who are

prevented from leaving for reasons of safety? People in hospital with mental health problems who

are not formally detained but are ‘detainable if wishes to leave’?

People in community settings who are locked in at night or for part of the day?

Children detained in community settings with the consent of their parents?

Page 11: Nick Hardwick HM Chief Inspector of Prisons

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Is it detention? (1)

Is the person confined in a restricted space for more than a very short time?

Has the person given valid consent to the confinement?

Is the state responsible? For example, independent care homes may breach article 5 of ECHR if they unlawfully detain an individual who has been placed there by, or with the permission of, a state authority.

Is the person free to leave? Duration of the measure?

Page 12: Nick Hardwick HM Chief Inspector of Prisons

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Is it detention? (2)

Physical restraint? Sedation? Contact with outside world? What is the overall purpose of measures to control or

restrict the individual’s movements? Is there a relevant comparator?

Page 13: Nick Hardwick HM Chief Inspector of Prisons

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Types of restraint (1)

physical – using physical force without equipment

mechanical – using equipment such as handcuffs or

leg restraints

chemical – using medication to restrain a detainee

environmental – for example, using seclusion to

restrict a detainee’s movement

Page 14: Nick Hardwick HM Chief Inspector of Prisons

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Types of restraint (2)

technological – for example, using electronic tagging, pressure pads or alarms to alert staff to a detainee’s movements

psychological – for example, repeatedly telling someone, especially a vulnerable person, that they are not allowed to do something or that it is dangerous, or depriving a detainee of something that is necessary for what they want to do, such as a walking aid

Page 15: Nick Hardwick HM Chief Inspector of Prisons

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Restraint concerns in health and social care settings (1)

Mental Welfare Commission Scotland (MCWS):– 113 incidents/20 required restraint– 3 ‘floor restraint’/others seated or guidance– 6 restrained regularly (fortnightly to daily)– Staff trained– 1 inappropriate incident– 1 institution with no records

Page 16: Nick Hardwick HM Chief Inspector of Prisons

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Restraint concerns in health and social care settings (2)

MCWS concerns cont.– People with different security needs on same

ward– Inappropriate use of chemical restraints– Lack of restraint – failure to assist a mentally ill

patient with terminal cancer to die with dignity

Page 17: Nick Hardwick HM Chief Inspector of Prisons

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Restraint concerns in health and social care settings (3)

Regulation and Quality Improvement Agency (RQIA)– Range of restraints found: rapid tranquilisation,

bed rails, lap straps, arm splints, specialist sleepwear

– Inadequate training and polices– Patients complained of injury

Page 18: Nick Hardwick HM Chief Inspector of Prisons

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Restraint concerns in health and social care settings (4)

RQIA concerns cont.– In non-secure settings:

Locked internal doors, locked external doors and gates, use of exclusion

Lack of understanding services were restrictive, failure to assess impact on individuals, poor assessment processes and little consultation with services users and/or their representatives

Absence of safeguards

Page 19: Nick Hardwick HM Chief Inspector of Prisons

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CPT standards for the use of restraint in adult psychiatric establishments

Subject to clearly defined policy Last resort and usually restricted to manual control Trained staff Physical restraints only used with medical

authorisation, for the minimum time possible and never as a punishment

Professional supervision of medication and sedation Seclusion should be avoided All incidents fully recorded to facilitate management

and oversight

Page 20: Nick Hardwick HM Chief Inspector of Prisons

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UK inspection and monitoring framework ‘Expectations’ (1)

1. Monitoring bodies should be independent of the authorities visited/ inspected and of the government. OPCAT Articles 17, 18(1)

2. Monitoring bodies should be impartial. SPT Guidelines 18, 19, 30

3. Monitoring bodies should have the right to publish their findings and to make recommendations for the purpose of preventing ill-treatment and improving standards in detention. OPCAT Articles 19(b), (c); SPT Guidelines 36

Page 21: Nick Hardwick HM Chief Inspector of Prisons

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UK inspection and monitoring framework ‘Expectations’ (2)

4. Monitoring bodies should have unfettered access to places of detention. Access should be granted even where monitoring bodies arrive unannounced. OPCAT Articles 20(c), (e); SPT Guidelines 25

5. Monitoring bodies should have unfettered access to all detainees and to information about them. OPCAT Article 20

6. The voice of the detainee is an essential component of any monitoring of places of detention. OPCAT Article 20(d)

7. There must be a focus on the prevention of ill-treatment. OPCAT Articles 1, 3

Page 22: Nick Hardwick HM Chief Inspector of Prisons

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UK inspection and monitoring framework ‘Expectations’ (3)

8. All places of detention should be monitored regularly. OPCAT Articles 1, 19(a)

9. Monitoring bodies should set their own criteria against which they monitor the treatment of and conditions for detainees. SPT Guidelines 12

10. Criteria for monitoring should be firmly grounded in human rights standards and should be transparent. OPCAT Article 19(b)

11. Monitoring bodies should be sufficiently resourced to perform their role. OPCAT Article 18(3)

Page 23: Nick Hardwick HM Chief Inspector of Prisons

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UK inspection and monitoring framework ‘Expectations’ (4)

12. The remit of monitoring bodies should be set out in statute. SPT Guidelines 7

13. The staff of monitoring bodies should be recruited and appointed in an open and fair manner. SPT

Guidelines 16 14. Monitoring bodies should promote and encourage

respect for diversity, both in their own workforce and when monitoring places of detention. OPCAT Article 18(2); SPT on Prevention 5

Page 24: Nick Hardwick HM Chief Inspector of Prisons

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Summary

Is it detention? Is the person restrained? Can they move where they wish? Is any restraint necessary, proportionate,

safe, authorised, recorded? Is there a human rights based, regular,

independent, preventative inspection and monitoring framework?