Reducing restrictive intervention in mental health services
NHS England, in conjunction with the Clinical Leaders Network, recently held an event for clinical and non clinical senior leaders from the NHS and Social Care services. 'The 6Cs are for everyone' event, which was held on Friday 4th July in Central Hall Westminster, London, provided an opportunity to share learning about embedding the values and behaviours of the 6Cs to improve patient and staff experience.
The '6Cs' were launched in December 2012 as part of ‘Compassion in Practice’, a vision and strategy for nurses, midwives and care staff, detailing the values and behaviours that are essential to the delivery of high quality, compassionate care.
What are the 6Cs?
Liz James, Quality and Improvement Lead in Healthcare for the South West and Wales, presented at the event:
“I was delighted to have been invited to speak at this event. My presentation covered ‘Positive and Proactive Care within Mental Health Services – How the 6C’s fit’. I am passionate about improving service users' experience of mental health services, and compassionate care is central to this. If, as healthcare professionals, we can work in a compassionate, proactive and positive way with our service users the need for the use of restrictive practices such as restraint and seclusion will reduce.”
Why restrictive intervention may become a thing of the past
Liz James explains: “Apart from exceptional situations, the use of restrictive measures such as restraint, seclusion, or the use of coerced medication is not in line with the idea of a recovery-focused service. Restrictive intervention can be an extremely confusing and frightening experience and may leave the service user in a worse mental state than before the incident.
“In my opinion, utilising restrictive practices as a first line response should become a thing of the past. The psychological effects of restrictive interventions should never be underestimated. Where physical restraint has been used on someone who has a history of being abused, the trauma caused can be catastrophic for that person, with feelings of humiliation and loss of dignity.”
Six steps to help prevent restrictive intervention in secure, personality disorder and Child and Adolescent Mental Health Services (CAMHS)
- Implement a recovery-based strategy to prevent restrictive intervention
- Utilise Behaviour Support Plans
- Focus on Positive Behaviour Support
- Conduct a post-incident support and review following an incident
- Utilise whole service approaches to reducing and managing conflict
- Use practical approaches to reduce and manage conflict
Six factors that can affect a service user’s experience of care
- Staff team or internal structure: Rules, routines, efficiency, cleanliness, custom and practice
- Physical environment: Security, quality of environment, access to fresh air, quiet areas
- Outside hospital or care environment: Family tensions, accommodation issues
- The ward or home community or person-to-person interaction: Copying behaviour of others, not seeing eye-to-eye with other service users
- Personal characteristics: A person’s behaviour may be driven by their symptoms such as someone experiencing paranoid ideas
- Regulatory framework or external structure: Mental Health Act, Mental Capacity Act