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Reducing the use of physical restraint in mental healthcare

Lancashire NHS foundation trust restraint team carrying out restrictive restraint for mental health

Mental health – the once taboo topic that turned viral, and is now unstoppable.

As well as professionals trying to break the stigma, the internet and social media in particular have played a huge part in the global conversation around mental health.

Social media has not only given the likes of health professionals a way to reach the public but it has given the public a huge voice. Every day another person has the confidence to speak up about their mental health. Everyday we are coming together as a community to help one another.

We’re breaking barriers and we’re curing through our voices.

But what’s become more apparent is that it has exposed how mental health is handled within healthcare our system. Many aspects of our current treatment and its consequences are under scrutiny. One thing in particular, is the use of physical restraints in mental health facilities.

Salford Royal NHS Foundation Trust, in the North West was in a geographical area where the levels of restraint use were amongst the highest in the country. (The Atlas of Shared Learning, NHS)

Restraint in mental health

Those that are struggling with mental health, may sometimes require restrictive restraints to keep themselves from harm, and others; including staff. This could be physical restraints, sedation or seclusion.

Although people may argue it, there are benefits to avoiding the use of physical restraints. Wards have proven that a decrease in the use of restrictive interventions are better at de-escalating situations before they lead to harm.

For this reason, reducing restrictive restraints should be an ambition across all mental health trusts. Nevertheless, reports show that restraints are not only used frequently, but they are overused.

In 2017, around 1 in 5 women who were admitted to mental health facilities were physically restrained. Despite guidance, restraints should be used as a last resort. (Restrictive interventions in in-patient intellectual disability services)

1 in 5 women were physically restrained, Source: Royal College of Psychiatrists, 2017

It’s clear to see that interventions are a problem that many trusts struggle to mitigate.

Reducing restraints

It’s important that Trusts monitor all incidents to understand when restraints are used and for what reasons. This will help to understand each step of the journey, and where certain aspects can change. Staff need to routinely measure:

  • Number of restrictive interventions
  • Frequency of each type of intervention
  • Duration of intervention (mean and range)
  • Trends; Time of day, week, month, year
  • Comparisons against the national benchmark

All of the above need to be consistently collected, that way each trust can identify and manage environmental factors that can increase the need for restrictive interventions. There are also other aspects to consider to really make a difference.

Firstly, staffing. Are particular staff more likely to use restrictive measure? Or is staffing low?

Secondly, procedures. Are all staff taking on the correct procedures when interventions occur?

Lastly, injuries. To keep wards accountable, regulators need access to data on the number of patient injuries sustained during restrictive interventions; was the harm to the patient justified by the level of harm prevented?

Training

One of the most important things to consider, is the training of staff. Maybe, the way to reduce interventions is ensuring the right sustainable training is delivered. On-the-job training can differ from person to person, and if they don’t have the correct resources trainees can be miseducated, leading to dangerous situations.

For restrictive restraints to decrease, training needs to be consistent and replicable. Training needs to be built on personal relationships around values and a person centred approach.

Practitioners need an effective training programme that enables them to spot factors which indicate whether a patient’s behaviour could turn violent, or not. These factors include:

  • Personal
  • Constitutional
  • Physical
  • Mental
  • Environmental
  • Social
  • Communications
  • Behavioural

Health and social care organisations can provide training for de-escalating techniques, which enables staff to:

  • Recognise early signs of agitation or aggression
  • Understand the causes of aggression or violence
  • Use techniques for calming and distracting
  • Recognise the importance of personal space
  • Respond in an appropriate, measured and reasonable way

A better solution

Lancashire Care NHS Foundation Trust approached us to create a unique, interactive elearning programme to change the way staff are trained. They wanted to provide staff with the opportunity to really understand trigger points, how to manage them, and how to reduce restraints.

Innovation Manager, Lindsay Hallworth said;

“Not only were operational managers keen to see some change, but also the training delivery team recognised there were improvements that could be made. In tandem with the Trusts Positive & Safe programme, we were tasked with finding a simplified but effective solution.”

“The main benefits of Near-Life™ was the digital availability of this training and the qualitative assessment information, with the flexibility to build in human factors evaluation. Furthermore, utilising digital media that mimics real life, aids delivery of training that is meaningful vs an artificial classroom setting.”

Collectively, we knew it was important to put learners into real situations for them to really understand how to respond effectively. With this in mind, we filmed scenarios at the trust, with their employees and some actors.

The scenarios take learners on a real journey, to really emphasise the steps that should be taken. Our interactive twist, allows learners to make their own decisions, enabling them to see the effects of every decision made.

Mike Todd, Near-Life™ CEO said:

“It’s been a real privilege to work with some of the talented and dedicated people who are delivering on the front line for the NHS. Violence reduction is an incredible important topic – and effective learning clearly has a critical role to play”

 

The Violence Reduction interactive learning scenarios to will go live later this year.

Need to find out more? Get in touch with our team.

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