Training standards on use of restraint could become mandatory for NHS in England

The Restraint Reduction Network has been commissioned to create the evidence-based standards

An independent network has been commissioned by Health Education England (HEE) to develop NHS training standards on restraint.

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HEE has asked the Restraint Reduction Network (RRN) to create the evidence-based standards, which could become mandatory for NHS-commissioned care in learning disabilities and mental health inpatient settings.

A HEE spokesperson said: ‘This key piece of work aims to develop a set of training standards to reduce the need for restraint, and the project is expected to be complete by the autumn.’

RRN chair and professor of mental health nursing at Manchester Metropolitan University Joy Duxbury has written extensively about restraint, and took part in a Channel 4 documentary, screened earlier this year, about unacceptable levels of restraint in a secure mental health specialist hospital in West Sussex.

‘A necessary piece of work’

Dr Duxbury, who is also chair of the European Violence in Psychiatry Research Group, told Nursing Standard: ‘We want to get this training right and consult widely given the importance of this issue.

‘If we can agree standards and processes in the healthcare setting, then we can tailor and extend these to social care and other sectors.

‘It is a very necessary piece of work.’

She said the RRN has championed approaches to minimise use of restraint practices for a number of years, particularly given the associated trauma and, in some instances, restraint-related deaths.

Person-centred approaches

In 2015 the National Institute for Health and Care Excellence published guidance on managing violent and aggressive behaviour among people with mental health problems.

Dr Duxbury said: ‘We know there is evidence to support the successful implementation of preventative, person-centred approaches to minimise the use of coercive practices such as restraint.

‘It will be important to get all organisations, including NHS trusts, to support the development of the new standards and recognise their significance in the current climate.’

She said the RRN project, due to begin later this year, would involve in-depth consultation about training, including input from nurses, whom she described as ‘key’ to the project’s success.

She added that the Mental Health Units (Use of Force) Bill becoming law would be ‘hugely important’.

A third reading of the bill, which was put forward by Labour MP for Croydon North Steve Reed, is due to take place in parliament tomorrow. 

The bill calls for provision regarding the oversight and management of the appropriate use of force in relation to people in mental health units and similar institutions.

Statistics on restraint

A Freedom of Information investigation by CPI International, which provides training on de-escalation techniques, revealed this week that 3,652 patients have been injured while being restrained during NHS treatment in mental health units in England. The data came from 48 of England’s 56 mental health trusts.

The investigation also found that only 13% of these trusts said they do not have a policy in place to reduce the use of restraint.

The data, covering 2016-17, showed that 97,000 restraints took place, and more than 2,600 staff were assaulted by patients during the use of restraint. Of the 48 trusts that responded in full, de-escalation training varied hugely.

Senior vice president of CPI International Chris Stirling said the organisation wanted to see statutory guidance to improve training standards and recording of restraint: ‘The use of restraint presents nurses with a range of complex issues, so it is critical that NHS nursing staff receive high-quality training that prepares them to address these complexities.’

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