Urgent proposals for dealing with violent patients are still awaiting government funding 10 years after the death that sparked them.
HSJ has discovered that a national training scheme for staff in acute mental health wards has been on hold for years, despite fresh evidence of increasing violent behaviour.
The need for better training in restraint techniques arose at an inquest last month into the death in 2004 of mental health patient Geoffrey Hodgkins. Untrained staff restrained Mr Hodgkins for 25 minutes, until he turned blue. The coroner, David Horsley, said he would write to the relevant authorities about national guidance on restraint.
But a national training scheme for dealing with violent patients was recommended after the death of schizophrenia patient David Bennett in 1998, who was held face down for almost half an hour by four or five members of staff.
The government then set up a group called the Management of Violence project, which submitted proposals for an accredited training scheme and updated guidance to the Department of Health by December 2006. These are yet to be implemented.
Marcus Roberts, head of policy at mental health charity Mind, said he had "huge concerns" about the delay.
"You would have hoped that the government would have found the money. It's a shockingly long time to elapse for something so vital," he said.
The Management of Violence project was run by the Care Services Improvement Partnership and the National Institute for Mental Health in England. It closed in May 2006.
Former project lead Colin Dale told HSJ he has continued "detailed discussions" with the DH and is "very hopeful" they will make a decision on funding this year.
The delay came to light as a joint Healthcare Commission and Royal College of Psychiatrists report this week revealed increasing levels of violence in mental health inpatient wards. The report - an audit of 211 mental health units - explains that the move to more community care has left inpatient mental health services dealing with only the most severe and complex cases.
More than a fifth of recorded violent incidents involved "resisting restraint or forced treatment", it found. Yet more than a fifth of clinical staff and 30 per cent of non-clinical staff said they had not received adequate training in dealing with severely challenging or violent incidents.
Mental Health Network director Steve Shrubb said the audit highlighted the need to provide better training for staff: "We're still experiencing high levels of disturbing behaviour in acute wards. I'd welcome a decision on the funding for this training to become available."
The training needed to go beyond restraint, he said, into understanding what triggers violent incidents.
Maureen McGeorge, manager of the audit project at the Royal College of Psychiatrists, said there were risks if people were restrained in the wrong way. But individual trusts are responsible for training staff.
A spokesman for the DH said: "We are currently developing a proposal for a new accreditation scheme for those who offer training in the physical management of violence."
Violence in numbers
85 per cent of nurses say they are involved in violent incidents
30 per cent of non-clinical staff say their training has not enabled them to deal with violent incidents
84 per cent of nursing staff are involved in using hands-on restraint
More than a fifth of violent incidents involve patients resisting restraint or forced treatment
30 per cent of patients think staff resort too quickly to hands-on restraint
Source: Healthcare Commission/Royal College of Psychiatrists National Audit of Violence 2006-07.
30 October 1998: David Bennett dies at The Norvic Clinic in Norwich. Nursing staff restrained him face down for almost 25 minutes.
December 2003: Independent inquiry into Mr Bennett's death is published: "A national system of training in restraint and control should be established within 12 months of the publication of this report."
January 2004: Management of Violence project is set up to advise on the safe management of violence in acute care settings.
19 November 2004: Geoffrey Hodgkins, a 37-year-old schizophrenia patient at St James' Hospital in Portsmouth, dies after being restrained by seven staff.
February 2005: National Institute for Health and Clinical Excellence publishes guidelines on the short-term management of violent behaviour in inpatient psychiatric settings.
May 2006: Management of Violence project closes.
October 2006: Independent inquiry reveals Mr Hodgkins died after being held face down for 25 minutes.
December 2006: Management of Violence project update reveals detailed proposals for a national training scheme had been sent to the Department of Health for approval.
Guidance for acute mental health settings is "being finalised".
January 2008: Coroner calls for national guidance on restraint techniques at inquest into Mr Hodgkins' death.