Opinion

Restraint reduction continues

Salli Midgley looks at concerns raised at the Positive and Safe Champions’ Network meeting.

Salli Midgley looks at concerns raised at the Positive and Safe Champions’ Network meeting

The Positive and Safe Champions’ Network meeting in Leeds in June aimed to continue to share good practice in reducing restrictive interventions and draw upon the work presented by trusts in England and beyond. Three clear themes emerged at the meeting that need to be given more consideration by clinicians.

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A seclusion room used by clinical services. Picture: Alamy

Clinical staff from Leeds and York NHS Trust gave a presentation on seclusion practice, with a focus on defining seclusion. It considered the definition of seclusion using a designated room in the Mental Health Act 1983 Code of Practice (Department of Health 2015).

Videos that showed different scenarios demonstrated the grey area of seclusion that could take place, without a defined room, when it is not long enough to be defined as long-term segregation nor is it preceded by a period of seclusion. In clinical services, this practice is known by a range of terms such as extra care, time out, low stimulus and high intensity care.

Missing from the code

It was clear that little is known about the practice of extra care. Although it is considered to be good practice and less restrictive than seclusion, we cannot define it clearly. It is not described in the Code.

However, patients might ask for it to support their high level needs. It can be used to deliver better outcomes for patients and manage certain presentations. If we invest resources in this grey area of segregated care, managing a person in an environment they cannot leave, the question remains: what is the best outcome?

A number of presentations focused on reducing prone restraint, an issue highlighted in a report by Mind in 2013. However, reducing one restrictive intervention does not necessarily curb others. 

Solutions put forward

One speaker hinted that while restraint was being used less, rapid tranquillisation was a significant care intervention. Research is needed to examine this issue in more detail and to assess whether, by reducing one intervention, other interventions are being used more. All restrictive interventions carry risks and require careful monitoring.

Another theme was the role of police within inpatient mental health settings. Inspector Michael Brown, who tweets as @mentalhealthcop, gave an articulate summary of the work of the police professional body, the College of Policing. He looked at how police and health care staff's duties and responsibilities intersect.

Clear definitions

While the College of Policing is not suggesting that police will not intervene when a criminal act has taken place, the police want to be clear about when the NHS is responsible for delivering care under the Mental Health Act.

The situation becomes vague once police are involved with a detained patient on NHS premises and it is not clear that a criminal act has occurred.

This evolving piece of work is one that all mental health professionals and health providers should watch.


References

Department of Health (2015) Mental Health Act Code of Practice. DH, London.

Mind (2013) Mental health crisis care: physical restraint in crisis. Mind, London.


Salli Midgley is assistant director of nursing for patient safety and safeguarding at the Humber NHS Foundation Trust, Hull

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