PROMISE: PROactive Management of Integrated Services and Environments

East of EnglandGeneric Health Relevance
Start Date: 1 May 2014 End Date: 3 Jun 2016

Background

The MIND report of June 2013 found huge variation in the use of restraint across England. In a single year one Trust reported 38 incidents compared to over 3000 by another. This could be due to either variations in reporting or practice. There were also 1000 incidents of physical injury following restraints.

There are fundamental contradictions at the heart of mental health, between care and control, risk and recovery. It can be argued that there is no place for force in supporting an individual’s recovery journey, however many aspects of the work of frontline mental health practitioners in reality involves the control and containment of people who may pose a risk to themselves or others. Thus the use of physical restraint, albeit viewed by most as a practice incompatible with the vision of recovery, carries on. Guidelines issued from the Department of Health in the “Positive and Proactive Care: reducing the need for restrictive interventions” document sets out the expectations for services, however there is very little guidance / evidence for what proactive care entails at the frontline.

Using the expertise and wisdom of patients and staff this qualitative study aims to bridge this knowledge/practice gap by exploring staff and patient experiences of physical restraint, their suggestions for reducing restraint, and their suggestions for promoting proactive care in mental health services. The findings of the study will inform the development of a proactive care framework aimed at reducing the need for physical intervention. This framework will influence training of Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) staff and staff practice development.

Research questions

The project aims to explore and answer the following questions in relation to adult mental health inpatient care:

  • What are patient and staff experiences of physical intervention? (Physical intervention refers to the physical restraint of a patient by one or more members of staff and encompasses any direct physical contact where the staff member’s intention is to prevent, restrict or subdue movement of the patient).
  • What impact has physical intervention had on patients and staff? • What do patients and staff perceive as alternatives to physical intervention?
  • What does a service that does not use physical intervention look like to staff and patients?
  • What are staff and patients’ understanding of and views on proactive management of services?
  • How can services meet Department of Health guidelines to reduce reliance on physical intervention?

The findings of the study will inform the development of a proactive care framework aimed at reducing the need for physical intervention. This framework will influence training of CPFT staff and staff practice development. The findings of this study will feed in to the framework alongside other strands of a wider project (PROMISE: PROactive Management of Integrated Services and Environments). 

Methodology

  • Step 1: Retrospective quantitative evaluation of all DATIX incident reports where physical intervention has been used during the defined period.
  • Step 2: Retrospective qualitative study of service user and nursing staff perspectives involved in the actual restraint.
  • Step 3: To role out an educational/practice development programme for frontline ward staff that is relevant, concise and co-produced by staff and service users.
  • Step 4: Comparison of rates of Physical Intervention pre and post training.

The project will use a Participatory Action Research (PAR) approach. The knowledge, skills and perspectives of those directly affected by this issue will inform and compliment the design, implementation and dissemination of this study.

A steering committee will oversee the running of the research, and will also review, on an ongoing basis, any ethical concerns raised. The committee will consist of researchers, clinicians (including nurses) and at least two service user representative.

Contact 
Dr Manaan Kar Ray
Manaan.Kar-Ray@cpft.nhs.uk