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News and Updates from today's Reducing Restrictive Practice & Interventions conference

Following the Chair's introductions, Paul Scates Peer Specialist Campaigner & Ambassador opens the conference with a session focused on 'Is control and restraint used as a last resort in the NHS?'.  Paul looks at:

• ensuring all forms of restrictive practices are reduced 
• are restrictive practices currently only being used as a last resort 
• how can we ensure a more positive supportive approach: prevention and de-escalation

Paul comments:

"Is control and restraint used as a last resort in the NHS?

What is the value of peer specialists?

Feels he can empathise because of his own experiences – try to avoid restrictive practices by adopting other tactics/techniques.

Try to identify a compromise if possible.

Use a Recovery Workbook to establish a way forwards – relational working with people to de-escalate conflict.

Support workers need more training and experience before they are ‘let loose’ with patients.

NICE guidance is about person centred care.  E.g. Paul and his dad have same diagnosis but their medication is very different.

Person centred culture.  Try to involve patients – empower them to take some responsibility for their treatment/medication.  Create a partnership.  Be non-judgmental.

Set the bar higher, don’t be satisfied with setting aim low and achieving the mark.

Look at it from a customer service relationship role perspective.  Look at personality, behavior, background.  Change the culture of treatment/units.

It might be quick fix to medicate but longer term solution is better than short term medication.

Must take the time to explain treatments and try and get to the bottom of what the problem is.  Not just think they are aggressive and need medicating – why are they being aggressive?

Treat people how you would like to be treated."

Paul's biography:

Paul Scates born and raised on the Jurassic coast in the Southwest of the UK. Educated at a top comprehensive school in Bournemouth, Paul later attended university and received his BA (Hons) in Arts & Events Production alongside BA (Hons) in Public Relations & Marketing.

Paul works and spends a good portion of his time in London as a creative events director and mental health ambassador.

Paul’s career has been vast and varied mainly due to his passion for life and his eclectic range of interests. Paul has a natural effervescence & gregarious nature which has allowed him to flourish and find his niche working within the entertainment & mental health sectors’.

Conference chair Professor Peter Tyrer continues the morning with a session on 'Violence and Aggression: Monitoring progress against the NICE Guideline' covering: 

• safeguarding NHS staff from violent and aggressive patients
• ensuring physical restraint is used as a last resort only
• changing the focus from managing to prevention and de-escalation
• meeting the CQC and CQUIN target
• monitoring progress against the NICE guideline in practice

Professor Peter Tyrer's presentation abstract:

Violence perpetrated by patients with mental health problems is commonly put down to psychopathology (i.e. It has very little to do with external factors and everything to do with internal conflict and distress).  Increasingly we are taught as mental health professionals how to manage violence, and yet at the same time are asked to do it with as little restriction as possible.  In the recent NICE guideline group on the management of violence we aimed to attract as much attention as possible to identifying the precursors of violence as well as giving guidance on the forms of management once violence occurs. Defusing violence is always the best strategy.

Professor Peter Tyrer comments: "NICE guidelines – broad development group - included adolescents, children, community settings, emphasis on service user concerns, revision of rapid tranquillisation, revision of guidance on restraint and seclusion.

Develop different frameworks for dealing with adolescents/children.  Lot of difference between a child of 5 and an adolescent of 16.

CAMHS training in management of violence and aggression in manual restraint methods for adults.

Only use mechanical restraint in high secure settings?  Some disagreement about this – seclusion room?  Mechanical restraints a difficult issue.

Depends on provisions of seclusion rooms.

Greater awareness of service user concerns – leads to a more cooperative approach and reduces use of restrictive interventions.

Advance decisions and statements – to convey a person’s preferences about future treatment

Reducing RI – training in person centred values based approach to care, collaborate with the service users.

CQC 2016 – statement about RI use being in line with CQC 2016

Why is violence diffusion so necessary? Injuries to staff, service users.  

Rapid tranquillisation is an RI – previously over used and ill defined.

Need to train – CQC will check this

Other requirements – resuscitation equipment, staff trained in this.

Manual restraint  - avoiding face down
Seclusion – only if detained in accordance with MHA.  Use designated room.  Use for short time as possible.

Post incident review

Research recommendations – manual and mechanical restraint, evidence of effectiveness of nidotherapy.  Named after Latin for nest, as good e.g. of environment which adjusts itself to any shape placed within it.  Analyse every part of the environment with the patient.  Identify misfit that might be adding to the psychiatric problem."

Download the full presentation here

Professor Peter Tyrer's biography:

Peter Tyrer is Professor of Community Psychiatry in the Centre of Mental Health at Imperial College. He has been interested in the most common mental disorders ever since medical student days and has been particularly interested in anxiety, depression and personality disorder in terms of classification and treatment ever since. He developed a new treatment for personality disorder called nidotherapy in the 1990’s while working in an assertive outreach team when realising that most of the patients remained stuck in limbo there as established treatments had all failed (, and this has been shown to reduce violence in a recent randomised trial.  He was editor of the British Journal of Psychiatry from 2003 to 2013 and is on the advisory board of 5 other journals, including the BMJ.

Speaking in the afternoon is Dr Peter Baker Senior Lecturer in Intellectual Disability University of Kent and Editor The International Journal of Positive Behavioural Support, who delivers a presentation on 'Developing positive behavioural support and supporting people with challenging behaviour', covering:

• understanding the context and meaning behind the behaviour
• developing supportive environments and skills
• training and educating staff in positive behavioural support
• developing behaviour support plans and primary preventative strategies
 with service users
• supporting people with challenging behaviour
• de-escalation techniques in practice

Peter comments:

"Understanding context and meaning behind the behavior – looked at vulnerabilities (biological and psycho social) which can lead to challenging behavior.   Maintaining processes – other people are causing this behavior (unintentionally!).  Working with challenging behavior provokes strong responses in staff – fear, trauma, which can be unhelpful when dealing with challenging behavior and also not good for the staff themselves.

Developing supportive environments and skills

Training and educating staff in positive behavioural support

Developing behavior support plans and primary preventative strategies with service users

Supporting people with challenging behavior

De-escalation techniques in practice"

Download the full presentation here

Peter Baker's presentation abstract:

This brief presentation will describe a framework and under pinning theory for understanding challenging behaviour. It is argued that this should be the foundation for any intervention model. It will also be argued that in keeping with our understanding of the causes of challenging behaviour, any attempt to prevent the occurrence should incorporates aspects of the whole system that supports the individual. The use of restrictive practices in the management of challenging behaviour is of increasing concern and the role of prevention of the occurrence of such behaviours is obviously linked to a reduction in such practices. Critical system wide independent variables in achieving a reduction in the use of such practices are described.

Peter Baker's biography:

Dr Peter Baker (BCBA-D) is a Senior Lecturer at the Tizard Centre, University of Kent. He worked as a Consultant Clinical Psychologist in Sussex for over 20 years where he had leadership responsibilities for Learning Disability Psychology services in East Sussex & Brighton & Hove. He lectures at the Tizard Centre on Certificate, Diploma, Graduate and Masters programmes and is widely published in the area of challenging behaviour and intellectual disability including the original Unified Approach and the recent guidelines on managing challenging behaviour in the NHS. He is the joint senior editor of the International Journal of Positive Behaviour Support.


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Masterclass: Complaints Handling & Response Letters
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Complaints Handling, Investigating, Resolving and Learning for Clinicians and Managers in Health and Social Care
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3 February 2017


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    The Tavistock and Portman NHS Foundation TrustInPracticeClinical Audit Support CentrePlayoutJust For Nurses
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