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Eliminating seclusion in practice and ensuring any instance of seclusion is reported and investigated

Dr Rachel Warner Consultant Psychiatrist & Deputy Medical Director with Dr Rhodri Hannan Clinical Psychologist Sheffield Health & Social Care NHS Foundation Trust eliminating seclusion in practice and ensuring any instance of seclusion is reported and investigated at today’s conference:

  • eliminating the use of seclusion in practice
  • developing and communicating your seclusion policy
  • the introduction and development of our seclusion review group
  • auditing seclusion practice
  • ensuring any instance of seclusion is reported and investigated
  • developing alternatives to seclusion
  • meeting the new national guidance: the challenges in practice

Dr Rachel Warner and Dr Rhodri Hannan full presentation is available for download at the end of this page.

In their presentation Rachel and Rodri stated:

We started by listing to our service users

What have we done?

  • Introduced Respect training – 2012, ending the use of prone restraint
  • Reviewed and rewritten policies
  • Developing recovery focussed care planning – 2013 and ongoing
  • Focussing initially on the use of seclusion - 2013
  • Project group set up to deliver a comprehensive strategy to reducing the need for restrictive interventions – Trust Board support 2014


  • leadership - commitment from Trust Board
  • measuring performance - data/outcomes driven quality assurance
  • Education and training – recovery principles: involving and empowering of people who use services, their families and advocates
  • developing programmes of activities and care pathways for people using services
  • using clear crisis management strategies and restrictive intervention reduction tools - PBS, descalation.
  • effective models of post-incident review including learning from critical incidents
  • Ensuring the environment is fit for purpose

Seclusion and physical restraint review group

  1. Initial strategic approach based on Six Core Strategies for seclusion and restraint:
  2. Leadership towards Organisational Change
  3. Using Data to Inform Practice
  4. Workforce Development
  5. Use of Seclusion and Restraint Reduction Approaches.
  6. Consumer/Peer (Service User) Roles in Inpatient Settings
  7. Debriefing Techniques.

Workforce Development Domain - Began an information gathering process about staff and service user views about Seclusion. Start the process of understanding issues that arise out of seclusion and that impact on its implementation. Included in the interviews was a second strand of questions related to post-incident reviews. Gathering broad information about processes related to support and management issues following range of incidents.

What is the purpose of the interviews?

  • To understand the nature of seclusion in SHSC inpatient services
  • To understand the consequences of seclusion for both service users and staff - psychological and physical
  • To develop knowledge of how seclusion is perceived by both staff and service users within SHSC

Semi Structured interviews were conducted with a total of 14 staff across all inpatient wards. Mix of nurses and support workers. Thematic analysis of the interview data was undertaken and a range of themes and sub-themes and how they are connected were identified from this for both seclusion and post incident review. Themes identified were Risk, Blame/Responsibility, Impact of Incidents, Environment, Measures that Would Reduce Distress, Compassion/Emotional Support, Barriers to Post-Incident Review and ‘Professional Roles.

Next Steps

  • Currently in the process of engaging service user experts by experience in a discussion about their experiences and views about seclusion.
  • This is being planned but requires sensitivity as for those who have been on the receiving end of the seclusion process it may be potentially traumatizing to revisit.
  • Options in terms of this work include individual interviews or a group based approach

Dr Rachel Warner Biography:

Rachel is deputy Medical Director and Consultant Psychiatrist at Sheffield Health and Social Care FT. She has worked in an adult community mental health team since 2000. Prior to taking up her post as deputy Medical Director she was the Clinical Director for Inpatient and Acute services in the Care Trust. During her time as Clinical Director the new training programme in restraint (RESPECT) was introduced across the wards and prone restraint taken out of practice. She led the development of training in Recovery focused care planning across Acute Services, which is now being rolled out across community teams. She is Trust lead for implementing the DoH guidance on Positive and Proactive Care and co-chair, with a service user, of the Trust Service User Engagement and Experience implementation group.

Dr. Rhodri Hannan’ Biography:

Rhodri is a Senior Clinical Psychologist and at Sheffield Health and Social Care FT. He has worked in the Low Secure Service in the trust since 2004 and is the Yorkshire and Humber Senate representative on the national Clinical Reference Group for Low Secure Services. He is currently chair of the Seclusion Review and Physical Restraint Group which is part of the Restrictive Practices Intervention group in Sheffield. This group is focused on developing strategy and supporting changing practice to reduce the use of seclusion and physical restraint within inpatient services in the trust.

Forthcoming events of interest:

Improving Mental Health Crisis Care
Thursday 30 April 2015, London

Stronger Code: Better Care Implementing the Changes to the Mental Health Act Code of Practice
Tuesday 12 May 2015, London

Masterclass: The Mental Capacity Act and Advance Decisions
Wednesday 13 May 2015, London

Masterclass: The Legal use of Control and Restraint
Thursday 14 May 2015, London

Download: Dr Rachel Warner and Dr Rhodri Hannan Presentation

10 March 2015


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