Hard Choices, Unheard Voices- Physical Interventions in Mental

Health In-Patient SettingsClinical Nurse Specialist – Security Lead

PMVA Instructor, Level 2 – WLMHT Model (Retired)RCN Forensic Nursing Forum

Committee Member

Alternative Title

Unless……(More later……)

Two Questions to bear in mind…

• What are the choices?• Whose are the voices?

Resolution to RCN Congress24th April 2013

• “That this meeting of RCN Congress asks Council to lobby UK governments to review, accredit and then regulate national guidelines of approved models of physical restraint “

• Proposed by the RCN Forensic Nursing Forum• Seconded by the RCN Older People’s Nursing Forum• FOR 470• AGAINST 1• ABSTAIN 1

On Taking a ‘Step Down’ Position

“Competing” NHS Agendas

• Commissioning• Leadership• Safeguarding• Compassion• Whistleblowing• And more…..

An emotive “hot potato”

• Winterbourne• Mid-Staffs• Deaths under restraint• Pain-compliance• Coercion• Capacity / empowerment / accountability

Key Points

• Death under restraint is not a Never Event• Google• Approved national standards would be NICE• Ongoing NICE review• Current system does not suit all areas • It’s like asking for water to be wet, and ice to

be cold…

One Trust’s JourneyService PI Model

Forensic Rampton C&R

Adult Rampton C&R

Older People Rampton C&R

Learning Disability Rampton C&R

CAMHS TCI

One Trust’s JourneyService PI Model

Forensic Broadmoor C&R

Adult Broadmoor C&R

Older People Broadmoor C&R

Learning Disability Broadmoor C&R

CAMHS TCI

One Trust’s JourneyService PI Model

Forensic Broadmoor C&R

Adult Basis PMVA

Older People SCIP-r

Learning Disability SCIP-r

CAMHS TCI

One Trust’s JourneyService PI Model

Forensic MAPA

Adult Basis PMVA

Older People SCIP-r

Learning Disability SCIP-r

CAMHS TCI

One Trust’s JourneyService PI Model

Forensic MAPA

Adult MAPA

Older People MAPA

Learning Disability MAPA

CAMHS MAPA

It was news to me…

Unless…

My Options Appraisal - 2009

• We use a BILD accredited model…

My Options Appraisal - 2009

• We use a BILD accredited model…unless…

Sheffield Trust

• Prone restraint has been banned in this Trust...

Sheffield Trust

• Prone restraint has been banned in this Trust...unless…

Positive & Proactive Care (DoH)

• No pain compliance…

Positive & Proactive Care (DoH)

• No pain compliance…unless…

Positive & Proactive Care (DoH)

• Breakaways must not cause pain…

Positive & Proactive Care (DoH)

• Breakaways must not cause pain…unless…

So we are left with

• Necessary• Reasonable• Proportionate

• “Positive and Safe” comes up with the goods

Are we any further on?