Introduction

Throughout the ages, virtually all complex societies have found the need for containment and control of behaviour by physical means. Indeed, it is difficult to imagine a world without prisons, police and the periodic need for society to impose its collective standard of behaviour on individuals.

While most people share a degree of comfort with the notion of physical intervention to maintain law and order, its use under the justification of mental health ‘care’ is deeply troubling to many, with some arguing it has no place at all (Davis 2004). The first words in any discussion about restraint must include the methods of avoiding the need for its use wherever possible. De-escalation, negotiation and the development of trusting relationships have been covered in detail elsewhere in this volume and the reader is advised to consider these issues as an essential first step. The focus here will be confined to the activity of restraint, assuming that due attention has already been paid to the methods of avoiding the need for its use.

Restraint and physical intervention: the questions

In mental health care, the use of restraint, both mechanical and inter-personal, has a long and chequered history. In recent years, the use of restraint has come under increasing scrutiny. In the UK and the USA, death during restraint has been increasingly reported (Appelbaum 1999; Paterson et al. 2003).