National Preventive Mechanism Sixth Annual Report 2014–15 Case studies Case study 1 Mr K has his own tenancy with day support and on-call night staff. Mr K doesn’t respond well to change, and when anxious he can be aggressive to others. His behaviour at times includes banging his head on doors and windows, throwing objects and hitting out at others. When his behaviour indicates that he is becoming agitated he can often be redirected to go back to his flat; at other times he seeks out the safety of his flat independently. There are times, however, when he needs to be restrained to maintain his safety and the safety of others. Protocols are in place to manage his distressed behaviour, which includes staff taking him to his flat, then withdrawing quickly. Actions taken at these times include locking the kitchen door and talking to him through his front door. Although all agree that this is the safest way to monitor Mr K at these times, neither the restraint nor seclusion have been legally authorised. There are times when Mr K seeks his own flat and self‑selects to be on his own. At other times, by banging on the door he is clearly stating that he does not want this. The use of restraint is not ‘one-off’ but part of a plan of care, and not legally authorised. Staff involved in this case have not recognised the implementation of these actions as a practice lacking legal validity. In this jurisdiction there is a legal framework which could consider the legal authorisation of the deprivation of liberty in these circumstances. In this case, either Mr K’s parents or the local authority should apply for a welfare guardianship order. 50 Case study 2 A ward in a mental health hospital for people with a learning disability had 10 patients waiting to move to suitable community settings. None of the patients were formally detained in accordance with the Mental Health (NI) Order 1986. All of the patients lacked the capacity to make decisions about their care and treatment independently. Exit from the ward was locked; internal doors were also locked, restricting the movement of patients within the ward. The patients in this ward presented with a range of complex needs; all had been in hospital for more than 10 years. However, none of the staff recognised the deprivation of liberty nor considered the interim safeguards set out by local government in the absence of a more robust legislative framework. None of the documentation available for individual patients recorded any identified risks or rationale for this level of restriction, or indicated that it was proportionate and the least restrictive option. The staff in this situation were asked to complete comprehensive multidisciplinary risk assessments and management plans for each patient to ensure that any deprivation of liberty/restrictive practice was proportionate to the assessed level of risk, and the least restrictive option that could be used.