There has been a recent policy shift on reducing the use of physical restraint (DoH, 2014). MIND’s Mental Health Crisis Care (MIND, 2013) report noted large variation in restraint use and raised concerns about restraint specific injuries, particularly from face down (prone) restraints. Patients who experience restraint report feeling stressed, fearful, angry, frustrated and confused. Even witnessing others being restrained can be distressing. Many of these feelings are also shared by staff (Wilson, 2017).
The PROMISE project sought to gauge restraint use within the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) and to work towards reducing it.
The project developed a governance framework to manage the large and complex transformation. CPFT made changes to incident reporting processes and the risk management database (Datix) to ensure it could capture sufficient data about restrictive interventions.
Staff and Service User Advisory Groups (SUAG’s) comprising of service users who had experienced restraint in a CPFT inpatient ward helped the study to understand experiences of restraint use. This provided the evidence base for initiatives implemented within CPFT.
Staff at all levels were empowered to think creatively about new initiatives that could be introduced and ways to eliminate reliance on force. Ward managers shared findings of innovative practice identified from staff, ensuring these were owned by frontline staff and not enforced from above. A shift to reflecting more on patients’ suggestions rather than simply saying ‘no’ was also seen. The project found that incidents noticeably decreased, with prone restraints decreasing by 58% (from 15/16 to 16/17).
Contribution of CLAHRC East of England
The project was informed by research, which was funded by CLAHRC EoE
What happened next?
The project has generated national and international interest, winning an award at the Patient Experience Network National Awards 2016, and findings were presented at the World Psychiatric Association Congress 2016. Due to the positive impact of the SUAG’s’ involvement, CPFT has continued to fund the group to support similar initiatives going forward.
The Care Quality Commission (CQC) highlighted how the introduction of a positive, therapeutic culture across mental health wards at CPFT has reduced the need for restrictive interventions. The project featured within a recently published CQC produced resource evidencing examples of good practice relating to reducing restrictive practices: http://www.cqc.org.uk/publications/themed-work/mental-health-act-restrictive-intervention-reduction-programmes.