Mind’s ‘Physical Restraint in Crisis’ report that came out in June of this year provoked a national debate about the use of physical restraint in mental health settings.
For those of us working in violence and aggression management in mental health trusts this was not a new debate, the idea of restraint reduction strategies have been considered for the last decade, but it gave prominence to what is a very complex issue. Hopefully it also gave the general public a greater understanding of the difficulties that sometimes arise when trying to care for patients who can be volatile and aggressive due to a mental health issue.
What hasn’t happened since the report came out is any new guidance on how we move this agenda forward. Yes restraint reduction has been outlined as a priority by bodies such as the Department of Health, NHS and NICE. Yes it has got Mental Health Trusts pushing harder to ensure better more accurate reporting of incidents and to look at where training interventions need to take place but nothing else has changed yet.
In my opinion the biggest barrier to moving this agenda forward is that there isn’t a clear understanding about what we actually mean by restraint reduction. Is it better to have 300 well planned, well carried out interventions or is it better to have 10 incidents of restraint that go badly and people get injured?
In the absence of centrally directed policy on how we tackle this issue I am going to review some of the best thinking that has come out around restraint reduction in the last decade. Firstly I’ll be looking at David Colton’s ‘Checklist for assessing your organization's readiness for reducing seclusion and restraint’.
On the back of a high number of recorded deaths in US medical services, David Colton was one of the main exponents of the idea that organisations should be signed up and working towards a reduction or elimination of the use of restraint and seclusion. I like Colton’s checklist because he suggests that you need to start by looking at your organisation’s culture. I’m sure we have all experienced situations where you have put in place a policy, guidance or training but it didn’t work as expected because people weren’t on board with what you were trying to achieve.
Although originally developed with mental health facilities in mind, including hospitals, residential treatment facilities, and outpatient settings, the checklist is adaptable to other settings including schools and school programs serving children with special needs. The checklist has nine areas that need to be considered:
You can view the checklist by clicking here, or view this presentation that explains the approach in more detail.
Colton’s checklist is very well evidenced and a good starting point but, in my opinion, organisations should be working to these guidelines anyway. What it doesn't tackle is the core issue of how we define restraint which comes back to my original point that we all need this common understanding of what it is we are actually trying to reduce.
Blogged by Gary Firkins –
De-escalation, Management and Intervention Lead for South Staffordshire and Shropshire Healthcare NHS Foundation Trust
For those of us working in violence and aggression management in mental health trusts this was not a new debate, the idea of restraint reduction strategies have been considered for the last decade, but it gave prominence to what is a very complex issue. Hopefully it also gave the general public a greater understanding of the difficulties that sometimes arise when trying to care for patients who can be volatile and aggressive due to a mental health issue.
What hasn’t happened since the report came out is any new guidance on how we move this agenda forward. Yes restraint reduction has been outlined as a priority by bodies such as the Department of Health, NHS and NICE. Yes it has got Mental Health Trusts pushing harder to ensure better more accurate reporting of incidents and to look at where training interventions need to take place but nothing else has changed yet.
In my opinion the biggest barrier to moving this agenda forward is that there isn’t a clear understanding about what we actually mean by restraint reduction. Is it better to have 300 well planned, well carried out interventions or is it better to have 10 incidents of restraint that go badly and people get injured?
In the absence of centrally directed policy on how we tackle this issue I am going to review some of the best thinking that has come out around restraint reduction in the last decade. Firstly I’ll be looking at David Colton’s ‘Checklist for assessing your organization's readiness for reducing seclusion and restraint’.
On the back of a high number of recorded deaths in US medical services, David Colton was one of the main exponents of the idea that organisations should be signed up and working towards a reduction or elimination of the use of restraint and seclusion. I like Colton’s checklist because he suggests that you need to start by looking at your organisation’s culture. I’m sure we have all experienced situations where you have put in place a policy, guidance or training but it didn’t work as expected because people weren’t on board with what you were trying to achieve.
Although originally developed with mental health facilities in mind, including hospitals, residential treatment facilities, and outpatient settings, the checklist is adaptable to other settings including schools and school programs serving children with special needs. The checklist has nine areas that need to be considered:
- Leadership
- Orientation and training of caregiver staff
- Staffing
- Environmental factors
- Programmatic structure
- Timely and responsive assessment and treatment planning
- Processing after the event (debriefing)
- Communication and consumer involvement
- Systems evaluation and quality improvement.
You can view the checklist by clicking here, or view this presentation that explains the approach in more detail.
Colton’s checklist is very well evidenced and a good starting point but, in my opinion, organisations should be working to these guidelines anyway. What it doesn't tackle is the core issue of how we define restraint which comes back to my original point that we all need this common understanding of what it is we are actually trying to reduce.
Blogged by Gary Firkins –
De-escalation, Management and Intervention Lead for South Staffordshire and Shropshire Healthcare NHS Foundation Trust