Restraints are unique procedures undertaken for restricting a person’s movement for various reasons. In the context of psychiatric practice restraint is as old as psychiatry. Prior to the eighteenth century people who were considerer mentally disordered and difficult to manage were restricted by shackling. The straight jacket or camisole was also used as a type of restraint.
There is little substantial written documentation regarding the historic development of restraint practice in the UK. However patchy information indicated that restraint was developed in the prisons in the 1980s and subsequently filtered unaltered into the police and psychiatric establishments. The origin of conventional manual restraint techniques might have started at St Thomas Hospital in Canada, which developed a restraint programme in 1974 (Wilson and Croker 1976). The St Thomas restraint training programme reportedly included self-defence skills, the use of pressure points and certain restraint techniques, which were influenced by a Korean style of martial arts. It is also possible that the UK prison restraint system was based on adaptations from the Canadian model. The prison restraint system is termed “control and restraint” (C&R. C&R is the terminology that legal and medical professionals are mostly familiar with.
The pathway to the prison restraint accreditation and curriculum development is hardly detailed. However, it appears that initially the Home office approved the use of restraint techniques in the prisons and perhaps that influence spilt over to the special hospitals, which provided what they termed “Home office approved training”. Nurses who were trained by those special hospitals in the 1990s assumed that they were Home office trained, when in fact, that was not necessarily so.
There are various interpretations to UK training system which comprises of two modules, which are self defence type skills referred to as “Breakaway techniques”. Breakaways are disengagement techniques used in one to one confrontations against physical attacks such as grabbing or choking or holding of the victim’s body parts. “Restraints techniques” are implemented by a team of three or four individuals. On observation, the UK restraint techniques are influenced by Judo, Ju-Jitsu and Aikido. Similar to the St Thomas restraint concept, the prison techniques also include the use of pressure point techniques and martial arts type holding techniques. The ultimate technique in the prison and certainly in the police and certain hospitals is the “Wristlock”. This technique is achieved by applying uncontrolled pressure on the flexed wrist of the person being restrained. Presently, C&R is referred to by a range of different terminologies each perhaps striving for political correctness rather than evidence-based development.
