Reducing restrictive practice through least coercive care
Reducing restrictive practice oversight group (RPOG)
Our reducing restrictive practice oversight group (RPOG) meets quarterly 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
- seek to understand and prevent the use of mechanical restraint
- develop guidance to support the application of the Use of Force Act alongside existing communities of practice 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
- raise awareness and share good practice in relation to secure transport
- develop a shared understanding of 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
In addition to this we have established a children and young person’s sub-group that is focusing on restrictive interventions within paediatric acute physical health settings for people experiencing acute distress and mental health difficulties.
Independent Care (Education) and Treatment Reviews (IC(E)TR)
Phase two of IC(E)TRs was completed in March 2023. The IC(E)TR oversight panel, chaired by Baroness Hollins, has monitored the progress of IC(E)TRs during phase two and their final report and recommendations, including the government’s response can be read here: Independent care (education) and treatment reviews: final report, 2023 – GOV.UK (www.gov.uk).
The Department of Health and Social Care, NHS England and the Care Quality Commission will continue to work together following the end of phase two and are making plans to recommence these reviews.
The NHS England Mental Health, Learning Disability and Autism Quality Transformation team are continuing to work with regional teams to identify and prioritise people who need an IC(E)TR. This ensures, during the current pause in the reviews, continued oversight of people in long-term segregation within the most restrictive mental health hospital environments. People will continue to receive care (education) and treatment reviews in line with the latest policy guidance.
HOPE(S)
The HOPE(S) model is an ambitious human rights-based approach to working with people in long term segregation developed from research and clinical practice. In partnership with Mersey Care NHS Foundation Trust, NHS England is funding the pilot and evaluation of this model across services in England.
The clinical model was developed by Mersey Care NHS Foundation Trust to reduce the use of long term segregation sometimes experienced by autistic adults, adults with a learning disability and children and young people when in hospital. Sixteen specialist practitioners have been recruited to deliver this important programme.
Visit www.centreforperfectcare.com for further information; and watch the short films below, about the importance of the HOPES model, by Claire Murdoch, NHS England’s National Mental Health Director, and Dr Roger Banks, former National Clinical Director for Learning Disability and Autism.
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.
- the 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 – (pdf, version to print and guidance) 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.