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Managing the risks associated with physical intervention: a discussion paper

Lee Hollins (Risk Assessor based in North Weald, UK)
Brendon Stubbs (Independent Lecturer in Older Adult Mental Health based in Yardley Hastings, UK)

The British Journal of Forensic Practice

ISSN: 1463-6646

Article publication date: 16 November 2011



The fallout from numerous inquiries into the death of patients, as well as the timely development of various pieces of anti‐discrimination and human rights legislation have all led to a major shift in the way physical restraint techniques are now used. Even so, techniques remain potentially harmful, with danger present in every application. This paper seeks to discuss this issue.


A review of the relevant literature revealed a large number of the psychiatric population are uniquely vulnerable to harm. The paper then examined how the way that this risk is managed could be enhanced.


The literature review revealed that a significant minority of patients in forensic settings engage in the types of damaging or injurious behaviours that may, as a last resort, require physical intervention. Physical intervention systems, some of which have migrated across into forensic settings from police and prison training portfolios, are often comprised of generic techniques which are applied in an unmodified form to patients; this mismatch can increase risk. The authors draw on a developing body of literature that examines how physiotherapists and manual handling experts can be used to enhance risk management strategies by formulating patient screening systems, applying bio‐mechanical knowledge to the configuration of holds, as well as developing technique risk assessment procedures and supporting trainers.


This discussion paper enriches the current debate on how risk can be managed within the context of restraint, as well as that of how best NHS resources can be used in practice.



Hollins, L. and Stubbs, B. (2011), "Managing the risks associated with physical intervention: a discussion paper", The British Journal of Forensic Practice, Vol. 13 No. 4, pp. 257-263.



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