Reducing restrictive practices on mental health wards

Restrictive practices are sometimes used on in-patient mental health, learning disabilities and autism wards when there is an immediate risk of harm to members of staff, the patient and/or other service users. Although these practices are sometimes the only option to keep everyone safe from harm, being restrained or secluded is generally a negative experience for service users, their families, the staff involved in the restraint, and anyone else who may witness the situation.

Ward teams are using Quality Improvement methods to help them understand and change their ward systems, working ‘upstream’ to encourage more proactive care and reduce situations when restrictive practices become needed. Staff have also been supported by a quarterly learning collaborative, bringing together teams from across the South of England to share, learn and reflect together.

a group of medical staff stand in a corridor talking together

Nine wards are currently participating in the Mental Health Safety Improvement Programme from Somerset NHS Foundation Trust, Cornwall Foundation Trust, Devon Partnership NHS Trust and Livewell Southwest. The South West AHSN is working with all trusts, either supporting ward teams directly or via organisations’ QI teams.

Devon Partnership NHS Trust and Livewell Southwest have worked together to develop an innovative simulation training programme to enable staff to practice and explore scenarios with each other. This is complementing the QI work underway on the wards by helping to develop skills and understanding of proactive care and use of restrictive practice. Staff commented that “the RRP session was incredible. The benefit of using simulation is huge. [The session] was a fantastic space for discussion and shared learning”.

Harvest Psychiatric Intensive Care Unit at Cornwall Partnership NHS Foundation Trust has been working on their QI project to reduce restrictive practice since 2021 and has tested a range of different change ideas, focusing on improving team communication, cohesion and empowerment, improving process and improving the ward environment. In early 2022 the team achieved reductions of 50% in both restraints and seclusions. There have been some increases recently, but the team can identify specific reasons for these relating to acuity of specific patients and are confident that the work has meant this was kept to a minimum.

“The South West AHSN has been a key partner in supporting and growing our wider system understanding of restrictive practices and has been crucial to the development of our internal programme of work. We are now developing more meaningful relationships both within and outside of the organisation, which has led to a renewed energy and motivation to share learning, explore new ideas and test changes to improve practice. We certainly look forward to building on this relationship moving forward and all the benefits it yields for us and those we serve.”

Simon Dallas, Quality Improvement Programme Manager, Devon Partnership NHS Trust