Children unable to breathe during restraint

Two reports obtained by Article 39 reveal there were 119 restraints in child prisons which compromised children’s breathing, or led to them being seriously injured, between 2013 and 2015.

It took 11 months for the Ministry of Justice to hand over the 2014/15 report, which was first requested in May 2015. A version of the report was given to us in December 2015, but virtually all of the contents were redacted. We complained to the Information Commissioner and, after further delay, the report was given to us last month. It shows that, between 1 April 2014 and 31 March 2015:

  • There were 65 incidents in six prisons (two juvenile young offender institutions and four secure training centres) where a child’s breathing was compromised, or they were seriously injured, during restraint
  • G4S-run Rainsbrook secure training centre had the highest number of incidents – 20 or 31% of the total
  • G4S-run Medway secure training centre had the second highest – 16 incidents (25%)
  • G4S-run Oakhill secure training centre had the third highest of the six prisons – 15 (23%)
  • The other three prisons had a total of 14 incidents (two of these, Hassockfield secure training centre and Hindley young offender institution, stopped detaining children in January and February 2015 respectively).

Of the 65 incidents, 71 warning signs and symptoms were recorded: 19 breathing difficulties; 18 occasions when a child complained  of being unable to breathe; 4 serious physical injuries; 6 incidents when a child vomited whilst being restrained; 8 petechial rash (haemorrhages); 11 incidents when a child lost consciousness or suffered reduced consciousness; and 5 incidents were listed as “other”.

In all of the incidents where a child suffered breathing difficulties and a petechial rash was observed, the head hold was used. The report does not state where the rashes were present: eye and face petechial are linked with asphyxial deaths. NICE clininal guidelines indicate that petechia should be suspected as child abuse if not associated with a medical condition or there is not a suitable explanation; and that such a rash on a child’s face, head or neck could indicate attempted strangulation and suffocation.

In one of the emergencies included in the 2014/15 report, a child was held in a seated hold in Rainsbrook. The child vomited. Notes in the report state the restraint was “prolonged” and “The handcuffs should have been applied much earlier” and there was no single person supervising the restraint (the role was changed between staff “several times”).

In another restraint in Rainsbrook, a child was reported to have “lost or reduced consciousness”. The notes refer to staff being “coached on application of head hold and risks to YP surrounding the use of arm across the throat”.

In another restraint in Rainsbrook, the recommendations include staff being told about “the Laws of use of force and its justification… and to be reminded if a young person verbalises they cannot breathe to ‘check and adjust’ as a minimum response”.

The report shows some children continue to be restrained on the floor, on their front or on their back, in breach of policy.

Large parts of the report summarising each incident, together with recommendations of the Behaviour Management and Restraint Governance Board in the National Offender Management Service, are redacted. In 20 of the 65 incidents, the Board gave no recommendations – which suggests it believes nothing could have been done to prevent the serious harm suffered by children.

The 2014/15 report does not state what the four serious injuries were but observes that one resulted from the “misapplication” of restraint and “a disregard by the staff member to respond to the young persons symptoms”, and another was investigated.

The shortest child to suffer breathing difficulties or a serious injury was 1.5m tall – less than five foot.

Serious incidents continued to take place in a child’s cell or “off camera”, in breach of policy.

The report shows Medway to have the highest rate of breathing warning signs or injuries as a proportion of restraints: 7% of restraints led to breathing difficulties or serious injuries. Next came Rainsbrook at 5%; then Oakhill at 4%; then Hindley at 3%; then Wetherby young offender institution at 1%; and, finally, Hassockfield at 0.8%.

The 2013/14 report, released to Article 39 last year, shows:

  • There were 54 serious injuries and warning signs that year
  • 48% of these serious incidents concerned children’s breathing (13 breathing difficulties and 13 complaints of difficulties breathing); and a further 30% involved a petechial rash. The report notes, “Petechial Rash and breathing difficulties constituted 78% of the [serious incidents]. This points towards a restriction of the mechanics of breathing to varying degrees”
  • Two incidents involved the child “appearing to lose consciousness”; both of these children had asthma. One child vomited after being given his/her inhaler “under restraint”
  • 7% of the incidents involved a child vomiting whilst being restrained: government guidelines state this is a medical emergency
  • Children suffered fractures whilst being restrained on four separate occasions
  • 39% of the 54 serious incidents occurred in Rainsbrook secure training centre, which was at that time run by G4S.

The Ministry of Justice report states, “The incidents that cause most concern are those where there is no camera coverage”.

Guardian news story here.

The Ministry of Justice does not appear to have made the reports available on its website.