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: 39,883
Range: Highest 3,346; lowest 38
Median: 455
• Face down restraint
Number of respondents: 27 (50 per cent of all trusts)
Total: 3,439
Range: Highest 923; lowest 0
Latest national figures at
http://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:
o Sheffield 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
o Hertfordshire 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 review
The 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 frameworks
All 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