Listening to experience, reducing restraint

Paul Farmer

Chief Executive

Mind

27 June 2014

mind.org.uk

About Mind• We provide advice and support to empower

anyone experiencing a mental health problem• We campaign to improve services, raise

awareness and promote understanding

• We work in partnership with over 150 local Minds to provide services tailored to their community

• People with mental health problems inform everything we do

The road to national guidance• Continued lack of ‘definitive guidance’ and

nationally accredited training following David ‘Rocky’ Bennett’s death in 1998 and despite further deaths and inquests

• Winterbourne View • Mind’s independent inquiry and crisis care

campaign• RCN Congress debate and leadership • People doing things differently – 6 Core Strategies,

No Force First, Safe Wards, Respect …..

Mind’s inquiry

“When we think of acute care, do we think of locked wards or someone being held face down? Or is this practice stopped and filed in the archives of history? What the people called for in this report is humanity – for care to be humane. I believe people can deliver this and more …..”

Paul Grey, Mind Inquiry Chair, Listening to Experience report

Mind’s campaign“need to change culture and

environment…. for support and accredited training for staff… underpinned by respect for service users and involving those who have been at the wrong end of restraint procedures” Dr S P Sashidharan

Mind’s campaign – what we found• Incidents of physical restraint

Number of respondents: 47 (87 per cent of all trusts)Total: 39,883Range: Highest 3,346; lowest 38Median: 455

• Face down restraintNumber of respondents: 27 (50 per cent of all trusts)Total: 3,439Range: Highest 923; lowest 0

Latest national figures athttp://www.hscic.gov.uk/suppinfofiles

Mind’s campaign – what we found

• Traumatic experiences• Failings in communication and in post-incident

review• Negative experiences of Black people and local

success in campaigning for change• Concerns among staff

“Restraint is overused in my experience. Often staff would not bother to try and

understand patients - and would just assume they were being irrational or delusional. My partner was treated very roughly when she

refused to take medication. This was because she had had bad side effects before and the staff refused to explain what medication she was being given. When I persuaded staff to

actually listen to her they eventually sorted it out”

[Carer’s quote in evidence to Mind’s inquiry]

I’ve suffered physical abuse when I was younger and being held down where someone forces their weight on you is triggering for me… it’s the last thing that’s going to make me conform; I don’t want them touching me.

Coming out of a psychotic episode is always scary, but the staff were always sure to inform me of what was going on so that I was not confused as to why somebody was holding my arms. They would repeat that I had been trying to hurt myself and they were doing this to protect me until they were sure I had understood.

Mind’s campaign – what we found

• Initiatives to work differently, for example:oSheffield Health and Social Care Foundation

Trust using RESPECT Training Solutions’ training and techniques

o IMROC sites using recovery principles in clinical practice and developing No Force First

oHertfordshire Partnership NHS Foundation Trust’s conflict reduction strategy

Positive and proactive

Positive and proactive

All services where restrictive interventions may be used must have in place restrictive intervention reduction programmes which can reduce the incidence of violence and aggression and ensure that less detrimental alternatives to restrictive interventions are used.

Positive and proactive – service user engagement

Wherever possible, people who use services, family carers, advocates and other relevant representatives should be engaged in all aspects of planning their care including how to respond to crisis situations, post-incident debriefings, rigorous reporting arrangements for staff and collation of data regarding the use of restrictive interventions.

Post-incident reviewThe aim should be to understand from the

person’s point of view how the service failed to understand what they needed, what upset them the most, whether staff did anything that was helpful, what staff did wrong, and how things could be better the next time. It is also important to establish whether anything could be done differently to make a restrictive intervention less traumatic.

Local policy frameworksAll policies must be co-produced with people who

use services and carers …The policy should explain how people who use

services, their carers, families and advocates participate in planning, monitoring and reviewing the use of restrictive interventions and in determining the effectiveness of restrictive intervention reduction programmes. This will include providing accessible updates and publishing key data within quality accounts (or equivalent report).

Positive and proactive workforce

“All learning should be co-produced”

Listening to experience, reducing restraint • The voices of people at Winterbourne View were

not heard• People with experience of being restrained spoke

out in Mind’s campaign• People with experience of being restrained

successfully influenced their Trust in Sheffield• Restraint reduction strategies include peer role

and debriefing – and engagement is relevant to all aspects

• Don’t try to do this without people who have experienced restraint

Any questions?

For more information:

Visit www.mind.org.uk

Contact – p.farmer@mind.org.uk