Reducing restrictive practice through least coercive care
Reducing restrictive practice oversight group (RPOG)
Our reducing restrictive practice oversight group (RPOG) meets bi-monthly to provide oversight on key pieces of work related to reducing restrictive practice across mental health, learning disability and autism inpatient settings. Our current areas of focus are:
- ensure restrictive practice data captured has a focus on protected characteristics including racial inequalities and gender to help identify areas for more targeted intervention
- develop guidance to support the application of the Use of Force Act
- supporting systems to implement the requirement set out in the Use of Force Act through a community of practice model and the positive and safe network
- support the development V2 of the Restraint Reduction Network (RRN) training standards and consider evidence base for physical interventions
- supporting systems to identify different types of restrictive practices and consider their impact by understanding definitions of different types of restrictive interventions including psychological restraint and coercion.
- support patient safety colleagues to develop guidance on Patient safety incident reporting within mental health settings
- develop resources aimed at commissioners and staff to describe what is meant by cultural restraint and how to identify it and prevent it
Mental Health Units (Use of Force) Act 2018
The Mental Health Units (Use of Force) Act 2018 – GOV.UK, also known as Seni’s Law. Olaseni (Seni) Lewis was a young Black man who lost his life following the disproportionate and inappropriate use of force in a mental health ward. After his tragic death, his family tirelessly campaigned for change. This led to the introduction of the Mental Health Units (Use of Force) Act 2018, which seeks to prevent the inappropriate use of force, ensure accountability, and promote transparency in these settings. The Act defines “use of force” to include physical, mechanical, and chemical restraints, as well as isolation (seclusion and segregation).
Independent Care (Education) and Treatment Reviews (IC(E)TR)
The IC(E)TR oversight panel, which was chaired by Baroness Hollins, produced a final report and recommendations which can be read here Independent care (education) and treatment reviews: final report, 2023 – GOV.UK (www.gov.uk).
Following the recommendations made in Baroness Hollins’ report it was agreed that IC(E)TRs would continue for a further two years from April 2024. The Care Quality Commission (CQC) are the lead organisation as of 1 April 2025. More information is available on their website: CQC’s programme of Independent Care (Education) and Treatment Reviews (ICETRs) – Care Quality Commission
CQC have specially trained Mental Health Act Reviewers (MHARs) who are undertaking the Chair role on IC(E)TR panels with the rest of the panel remaining as independent experts alongside the responsible commissioner. A new national oversight group has been established to ensure learning is captured and actions from individual reviews are followed up.
HOPE(S)
The HOPE(S) model is a human rights-based approach which was developed by Mersey Care NHS Foundation Trust to reduce the use of long term segregation that is sometimes experienced by autistic adults, adults with a learning disability and children and young people when in mental health hospital.
The National pilot has now concluded, and Commissioners can discuss the HOPE(S) model in more detail and explore costings for local areas by contacting: hopes@merseycare.nhs.uk
Reducing restrictive practice resources
We have produced two resources for adults and children with a learning disability, autistic adults and children, the staff who support them and their families to inform and empower people to speak up about restrictive practice.
Both resources have been co-produced and piloted with people with lived experience of restrictive practice in hospital settings and professionals.
The resources take a human rights approach and aim to help people understand their restrictions and be more involved in developing least restrictive options. They also include information about who to speak to if there are any concerns about the way restrictions are used.
- What are restrictive practices easy read booklet is designed for autistic adults and adults with a learning disability. It includes information about different kinds of restrictive practice and why they may be used.
- The My Rights magazine is designed for young people. It is written in plain English and in a style that allows young people to easily turn to the topic they need and to personalise it through writing and doodles. It includes information about rights, types of restrictive practice, real stories and top tips from young people about ways to speak up.
Young people were very clear that the magazine will be most useful as a hard copy. They wanted to be able to write or draw on it, rip out and keep key pages or tips, and take it with them to meetings to remind them and others about their rights and needs. Please consider how you can work in partnership to promote this great resource and achieve hard copies for the young people in your area.
Staff working in hospital settings should share these resources with the people they support and actively work with them to help them understand and be involved in decision making around the use of restrictive practice.
Senior intervenors
The National Adult Senior Intervenors Pilot Project was set up in response to Baroness Hollins’ recommendation for the introduction of an additional senior person to support local services to plan for discharge, guide where there is challenge and agree actions to facilitate a reduction in restrictions. This project built on the positive evaluation of the pilot of Children and Young People’s Senior Intervenors. The ultimate goal of the senior intervenors was to establish and oversee a robust plan for discharge from both long term segregation and hospital.
The senior intervenors’ work focused on cases where progress was not being made and there was concern for the individual’s wellbeing. The senior intervenor worked with people on a case by case basis to find solutions to barriers that were preventing the individual from moving to less restrictive settings or into the community.
The Adult Senior Intervenors Project was funded until March 2022 and was extended to 31 March 2025 to ensure those individuals who had a senior intervenor continued receiving an intervention, until discharge or progression to less restrictive settings had been achieved.
Following the publication of the evolved operating model in 2024 a process to enable local systems to commission senior intervenors and senior children’s intervenors was established, based on the key principles of locally commissioned/requested and independently facilitated.
This all-age support can now be commissioned by local systems wherever a person is ‘stuck’ in a mental health hospital due to system rather than clinical issues. It is expected that many of these people with longest lengths of stay will now be identified through local Dynamic Support Registers, C(E)TR panels, and/or local oversight processes.
The intervenors who supported the national pilots can be requested via the NHS IMAS specialist talent pool or by contacting nhs.imas@nhs.net