National Preventive Mechanism Third Annual Report 2011–12 Although the use of force and restraint in the children’s secure estate has been most contentious in England and Wales, it is also closely monitored by relevant NPM members operating in Northern Ireland and Scotland. In a joint inspection of the Woodlands Juvenile Justice Centre in 2011, for example, Criminal Justice Inspection Northern Ireland (CJINI) and the Regulation and Quality Improvement Authority (RQIA) noted a significant reduction in the use of force and found effective systems to record, analyse and learn from restraint incidents. RQIA also found a significant reduction in restraint incidents during its inspection of Lakewood Secure Care Centre (a secure children’s home). This reduction resulted from action to address previous recommendations by RQIA, including the setting up of a weekly behaviour management group to analyse each incident of restraint, address any issues arising from the incidents and learn from them. Additional training for staff had also been provided. Health and social care settings In some health and social care settings where residents are not legally detained, the restrictions of liberty applied to residents are such that they may constitute de facto detention. This is an issue the NPM members will explore further in 2012–13. The findings from work in 2011–12 described below include instances of force and restraint in places of detention, as well as restrictions of liberty in non-secure residential settings which, when taken together, may constitute a deprivation of liberty. In Scotland, the Mental Welfare Commission for Scotland (MWCS) safeguards the rights and welfare of everyone with a mental illness, learning disability or related condition. This includes making regular visits to monitor the treatment of those detained under mental health law. It also includes visiting other residential settings in which people’s liberty may be restricted through the use of force or restraint. In 2011–12, MWCS made a series of visits to people with learning disabilities in hospital care and assessed the use of restraint over a six-month period. Of the 113 people whose care and treatment were assessed, 20 had required some level of physical intervention. Three had required floor restraint while the remainder had required seated restraint or minimal guidance from one area to another. Six of the 20 were restrained regularly (from fortnightly to daily restraint). MWCS found that all staff had appropriate training but was concerned about one incident in which inappropriate restraint techniques were used, and one unit that was unable to find its record of restraints. In those cases, MWCS has undertaken follow-up action.11 In a review of people with severe and enduring mental illness, MWCS was concerned about people with different security needs placed on the same ward. This resulted in unnecessarily secure environments for some of the patients. MWCS made several recommendations aimed at the minimum use of force to ensure individual safety.12 During an investigation into the care and treatment of a woman with dementia, MWCS found that chemical restraint was used inappropriately. While staying at a hospital over a 12-day period, the woman was given fluids by a drip but no nutrition. 11 MWCS, Themed visit to hospital units for the assessment and treatment of people with learning disabilities ( July 2012). 12 MWCS, Left Behind ( January 2012). 22