Use of restraint and force: steps towards greater transparency and accountability

Ethical training plans and sharing people’s lived experiences of mental health services can only be welcomed

Ethical training plans and sharing people’s lived experiences of mental health services can only be welcomed, writes Lee Hollins

On February 5, the Restraint Reduction Network (RRN) will launch a set of draft training standards developed with Health Education England to provide a benchmark against which all restrictive intervention training can be evaluated.

Picture: iStock

The standards cover training that has a restrictive intervention component and are designed to be applicable across health, social care and education.

They will become mandatory for all NHS-funded or commissioned mental health services in England, as well as services for people with autism, people who have learning disabilities and those living with dementia.

The standards have a focus on giving staff and carers the skills to prevent crisis and distress happening in the first place, and alternative responses to use when people are upset. They also cover post-incident support and recovery for everyone, as well as trainer competences.

Influenced by the experts

The RRN steering group is made up of leading clinicians and academics, voluntary organisations and people with lived experience committed to dismantling cultures and attitudes that historically have led to the unthinking use of restrictive interventions. It is chaired by Manchester Metropolitan University professor of mental health Joy Duxbury.

The standards have been influenced by ‘experts by experience’ such as John (not his real name), who has lived experience of mental health services. John shares his insights with those seeking to optimise care provision.

Such experience is often painful to acquire because a significant aspect of the experience, and John’s in particular, is of being restrained… of being coerced… of being forced face down on the floor… of having his arms twisted… of people ignoring his screams. Sadly, this practice can still occur.

After ten years of recovery, John feels stronger, and has more good days than bad. He has made enormous progress through art therapy. He now shares his experiences with trainee mental healthcare practitioners, and his testimony has the power to make people think twice about resorting to restraint, to look deeper into a person and to recognise distress. These insights might just save a life, or at least prevent needless pain and distress.

Pain-soaked experiences

‘I speak at conferences and on university courses,’ John told me during one interview.

And what is the reward he most commonly receives for sharing his pain-soaked experiences? ‘People really take something away from it. But, when it comes to paying me, they say “Oh, you’re the expert by experience. Here’s your lunch money.”

‘I can’t help but think that, the moment you disclose you are an ex-patient or ex-service user, they think you are somehow less. You are not a doctor or a nurse or someone with a professional qualification. You are just someone who was restrained.’

John is keen to point out that some of these staff were instrumental in his recovery, and were empathic, sensitive and supportive. Others however were too ready to use force when he was in crisis. It seems he was a risk to be managed, and restraint provided a quick and powerful means to an end.

'Restrictive practices are being critically examined at all levels'

‘I spoke about my experiences recently at an NHS event. At the end, I noticed an older man crying. I went and spoke to him. It turns out he had been a mental health nurse, one of those who had used restraint techniques on people… and hadn’t stopped to think what it was like to be on the receiving end.’

Change comes at a price

Thankfully, restrictive practices are being critically examined at all levels. The soon-to-be-launched draft standards call for training providers to engage with individuals such as John when developing curricula.

Change comes at a price. So does pain suffered by the likes of John. We can’t afford not to pay our way to enlightenment, and John richly deserves more than lunch money.

Further information

About the author

Lee Hollins is lead assessor at the British Institute of learning Disabilities, Birmingham, and a contributor to the RRN training standards

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