THE USE of dangerous techniques such as chemical sedation and physical restraint to control mentally ill patients has tripled in some parts of Scotland despite moves to clamp down on the practice, shocking new figures show.

A Herald on Sunday investigation can reveal face-down restraint, where psychiatric patients are pinned to the floor, was used more than 2000 times last year.

And rapid tranquillisation, where a patient is either given oral medication or injected with a sedative, has also risen dramatically since 2016 in the four health boards which recorded its use.

Face down restraint is considered the most dangerous type of intervention because it can result in compression of the chest and airways and put the person being restrained at risk.

In 2014, the UK government described it as "outdated" and invested £1.2m in training for NHS staff south of the border to cut down on its use.

However our investigation has found that some patients have been restrained in this way more than 15 times in a single year - an average of at least once every three weeks.

Overall the practice has risen by a third across all health boards in Scotland, but in Dumfries and Galloway and Tayside, it has more than doubled since 2016.In Fife, its use has risen by 315%.

Rapid tranquillisation has been described by health watchdogs at the National Institute for Health and Care Excellence (Nice) as a 'last resort' when all other methods have failed.

But figures obtained by the Herald on Sunday show that NHS Fife has seen a 600% rise in the use of the sedation technique, from 33 times in 2016 to 231 times in 2018, while staff at the State Hospital used the medical sedation method 155 times in 2018 - a 40% rise in three years.

Forth Valley's use has doubled since 2016, - from 21 to 42 times - while Lothian's use has risen by 15% in the same period from 365 times in 2016 to 421 times in 2018.

The revelations come after a report into Carseview, a mental health unit in Dundee, was leaked earlier this week and found face-down restraint to be overused and carried out by staff who weren't trained properly.

It prompted an outcry from experts who said the methods should only be used in the last instance, after everything else has been tried.

One woman, who has been both restrained and sedated while in hospital for bipolar disorder, said the methods were routinely used as a first response.

A 45-year-old woman from the Highlands said:" I was having a manic episode, and at one point I was in a spiritual room praying. I think this was misinterpreted and they kept telling me to go back to the ward. I didn't want to go as I thought they were going to inject me.

"They didn't explain anything - they don't tend to. They called from a guy from the locked ward, and he gave me a Chinese burn unprovoked. The next thing I knew I was being pinned down, he was holding my wrist forward and I felt like it was going to break.

"He wouldn't release me and it was quite scary. My dad said he thought I had PTSD afterwards, I was really traumatised.

"It seemed an overreaction and I think they had misinterpreted what I was saying or doing.

"I was also injected before as well because I was singing in the main ward. They asked me to go back to my room which I did, but they injected me anyway. I asked them what the side effects were of the injection and they didn't explain, they just held me down and injected me.

"I've looked up advice afterwards and I know it is supposed to be used as a last resort, but it wasn't in my case.

"I think quite often they are understaffed, so it’s possible that it takes less staffing time to let you lie there for a few hours than speak to you about what's going on."

Politicians have described the findings "seriously alarming" and have called for an urgent inquiry into the rise of the both techniques across the country.

Monica Lennon MSP, shadow health secretary and Labour's health spokeswoman said the data illustrates how widespread an issue both rapid tranquillisation and face-down restraint are across Scotland, and not unique to Carseview in Dundee.

She said: "Prone restraint involves patients being held face down and it’s alarming that this and chemical restraint is increasing across Scotland.

"We need to know why this is happening as it should be a measure of last resort only when the life of a patient is in danger. We should be avoiding interventions that can induce trauma and fear in vulnerable people.

“I’m already concerned about staffing levels across our NHS and have been calling for a national review of mental health services because we know the system is struggling to cope and deliver timely, safe, rights-based care to everyone who needs it.

"The Herald on Sunday investigation should be a further wake-up call to the Scottish Government that Scotland’s mental health services are in a state of crisis. For too long, people and their families haven’t been listened to and it’s not isolated to Carseview and Tayside.

"I have backed the campaign by Gillian Murray and Karen McKeown for a national review of mental health services and I will be writing again to the Health Secretary and the Mental Health Minister, urging them to back this.”

The Scottish Liberal Democrats' health spokesman Alex Cole-Hamilton MSP said patents' lives could be at risk.

He said: "These reports suggest patients are being handled in a dangerous and potentially life-threatening fashion.

"Restraint is supposed to be a last resort but these figures show that in many health boards it is becoming more and more common.

"Ministers should publish the complete report into restraint at Carseview as soon as possible and come to Parliament to make clear how these lessons will be applied, not just in Tayside but across the country."

A Scottish Government spokeswoman said: "We are absolutely clear that everyone should be able to feel safe whilst receiving treatment or working in our mental health services.

"The use of physical restraint and rapid tranquillisation should only ever be a last resort to ensure safety, the shortest period of time.

“As we work to further improve our mental health services the experience of patients, their families and staff are key to reshaping treatment and support.”


Alison Whyte, 51, a PA from Edinburgh has been hospitalised four times for bipolar affective disorder. She has been subjected to face-down restraint twice while in a psychiatric ward, but said her medical notes contain no reference to it.

She said: "I first presented myself at hospital in summer 2014, and within hours I was sectioned under the mental health act. This was my first experience of life detained in a psychiatric ward.

"During my stay I was forced into prone position on two separate occasions. To this day I really don't know why.

"The first time was absolutely terrifying, I've never known an experience like it. It was brutal beyond belief. There was no warning about what was going to happen.

"I don't remember what happened leading up to the assault but I do remember the incident itself. I will never forget it. I was wrestled to the ground by a number of nursing staff in the ward's stark lounge, I think four nursing staff held me down, forcing my body face down on the ground.

"Staff sat on the backs of my legs, at my calves and held my arms behind my back whilst other nursing staff looked on. I remember trying to fight back and whilst pinned down on the floor, it was futile but I guess an instinctive reaction. I was absolutely terrified, never in my life have I been assaulted like that.

"I could not believe I was in hospital and that nurses were attacking me - I was then injected in my backside with some sort of "calming" chemical, totally against my will.

"The second time I was put into prone position I had returned from a tribunal where I learned my I would remain in the hospital indefinitely.

"My memory is scant but I do remember being pinned down, face down on my bed by I think three staff. I was still wearing a nice dress and pair of heels (I wanted to make a good impression at the hearing), and again, staff sat on the backs of my legs and pulled my arms around my back before injecting me with a "calming" chemical.

"Again, the injection was totally against my will. This time I was not afraid, I was furious, I simply could not believe I was in this unreal situation."