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Restrictive Interventions & Practice

This conference focuses on reducing restrictive interventions in line with national guidance and ensuring adherence to the National NICE Quality Standard on Violence and Aggression.

Learning from Lived Experience

Sarah Rae - Co-Founder of PROMISE and Expert by Experience

PROMISE (PROactive Management of Integrated Services and Environments)
PROMISE was a complex quality improvement intervention designed to bring about culture change regarding the use of restrictive practices in mental-health settings. Using restrictive practice is incompatible with a vision of recovery, rather a caring response to distress is needed promoting dignity and respect and paving the way for true enablement for people with mental health challenges. This ethos was the cornerstone of the PROMISE programme. PROMISE began as an initiative to support staff and service users on a journey towards eliminating reliance on force within one foundation trust in England. 

Sarah Rae talked about being able to recognise the changes that are needed to reduce the need for restraint and intervention.

Improving the culture and environment can reduce the need for restraint, the No Audit encourages staff to think if they could have said yes or what they could have done to meet half way - a can do culture. 

For example allowing service users to be woken up in a way that is more comforting such as offering them a cup of tea or even just being more polite in how you interact with them. There can be an “Us and Them” culture as a result of the stable door interaction when giving medication to service users. Patients may want to have a confidential chat prior to taking their medication and if they feel this can’t happen they can become distressed resulting in the need for intervention.

There needs to be a focus on enhancing the patient experience, a shift to a more positive and holistic approach.

Full Powerpoint Presentation

Minimising the use and risk of restraint and phusical interventions

Dr Anthony Bleetman - Consultant in Emergency Medicine & Specialist Committee Member, Violence and Aggression National Quality Standard, NICE 

Dr Bleetman is a consultant in Emergency Medicine. He has developed an interest in the safety of physical interventions following some research work with the Police on use of force. He has been able to assist physical intervention trainers and managers across a broad range of organisations where behavioural and physical interventions may be required. He received a PhD for developing safety standards for body armour. He was on the clinical guidelines group for NICE guidance 25. He is a member of a Ministry of Defence scientific advisory committee dealing with the medical safety of less lethal weaponry. He continues to work across a number of disciplines to minimise the risk of physical interventions and restraint. 

Tony said where there was once a “one size all” approach to training staff with regards to administering restraint, research has now shown this is not effective. It’s important to understand the service user profile within your service or trust and the process of reporting incidents effectively as a means of protection. Once this is known it will help in the reduction of restraint.

Full Powerpoint Presentation

Moving the focus to prevention and raising the standards for training
Sarah Leitch,
Director of Development, British Institute of Learning Disabilities (BILD) and Restraint Reduction Network 

We need to talk about restraint - short film made for Health Education England with three experts by experience. 

Abolishing physical interventions and restrictive practices at springbank ward - Lessons from a specialist personality disorder unit

Dr Jorge Zimbron - Consultant in General Aldult and Rehabilitation Psychiatry Cambridgeshire and Peterborough NHS Foundation Trust

Springbank ward is one of only two specialist personality disorder units in the NHS. It has developed a pioneering approach at managing severe borderline personality disorder without the use of restrictive and coercive practices. 

There have been 2 distinct periods for the ward using different treatment models: 

The original treatment model focused on risk containment (May 2011 - May 2015). There was no pre-defined treatment duration and most patients were under a section of the Mental Health Act and on enhanced observations. This is the most common way of managing patients with chronic suicidality across the UK.

The new treatment model focuses on shared-decision-making, recovery and positive-risk taking (May 2015 onwards). 

The talk will compare both periods by using incident rates and outcome measures collected between 2011 and 2019. It will also discuss the various service improvement initiatives needed in order to develop the new programme. Finally, one of our service users will provide a personal account of what it is like to be treated under both treatment models.

Full Powerpoint Presentation

Working withpeople with lived experience to improve the training and education of frontline staff

Jack Pooler - Head of Safety Central and North West London NHS Foundation Trust Lauren Markham - Peer Support Trainer Central and North West London NHS Foundation Trust

Jack Pooler is Deputy Director of Safety and Lauren Markham is the Senior Peer Trainer for Central and North West London NHS Foundation Trust (CNWL). The presentation is called Using co-production to make training more recovery focused and in the spirit of co-production this presentation has been written and delivered between the two ensuring the two perspectives of someone working within services as well as the service user perspective. 

The talk outlines the journey CNWL has taken to embed people with lived experience within the safety team and how the role of the Peer Trainer has shaped not only the training staff receive but other strides taken to improve the safety of services overall. 
Stories are important and Lauren tells her own story from her lived experience to how she is now a Senior Peer Trainer within the team. The CNWL story starts with why changes were required and how various people and systems within the service evolved to ensure the training became more recovery focused and the development of the peer role was one of these major initiatives. 

Full Powerpoint Presentation