Many aspects of the management of acutely disturbed behaviour have only relatively recently come under systematic scrutiny. Perhaps regrettably one of the last amongst the range of strategies that may be employed to be subjected to rigorous examination has been physical restraint. Considerable debate has recently taken place around what represents good practice in this sensitive and controversial area but the continuing dearth of research in some aspects of this area of practice has meant that this discussion has arguably been over reliant on 'expert' opinion. Questions continue regarding some fundamental issues of restraint, including the relative risks involved in alternative approaches, and anxieties have been expressed about the potential for injuries and death to result from restraint. This article outlines the results of a survey that sought to explore the incidence of deaths associated with restraint in health and social care settings in the UK. The outcome of an initial analysis of the cases identified is then discussed, with reference to the literature on restraint-related deaths, in order to identify the implications for practice.

As a principal control measure, physical intervention is intended to be a skilled manual, or hands-on, method of physical restraint implemented by trained individuals, with the intention of controlling the aggressive patient, to restore safety in the clinical environment. Physical intervention is however a contentious practice. There have been reports in the literature of negative psychological views from staff and patients on the procedure. Although formal structured training was introduced in response to concerns around patient safety during restraint, concerns remain that PI is sometimes construed as a stand-alone violence prevention initiative. Its potential for misuse, and overuse, in corrupted cultures of care has emerged as a social policy issue. The following paper critically explores the literature on training in physical intervention in the United Kingdom.

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The influence of these frames has influenced the nature of responses to the problem but the recent dominance of the individualizing frame is being challenged by the emergence, or perhaps re-emergence, of co-creationism.