Skip navigation

Is Control & Restraint used as a last resort in the NHS? Asks Alison Cobb & Paul Scates

Alison CobbAlison Cobb

“When we think of acute care, do we think of locked wards or someone being held face down? Or has this practice been stopped and filed in the archives of history? What the people called for in this report is humanity – for care to be humane. I believe people can deliver this and more …..”Paul Grey MIND Inquiry Chair, Listening to Experience Report

Paul Scates, Peer Specialist at Dorset Mental Health opened the conference discussing the lived experience of restraint and his own experience of both good and bad restraint. In Pauls opinion there is a need for restraint but it is often not used as a last resort. Paul questioned how often service users are involved, particularly in reviewing why restraint was used. Paul said restraint practice should be about taking measured risk and de-escalation and not just a knee jerk reaction.  Using the example of safe wards in Dorset Healthcare paul talked about the importance of making staff human beings and the importance of explaining to service users about restraint and why it may be used. 

Alison went on to say that all services where restrictive interventions may be used must have in place restrictive intervention reduction programmes which can reduce the incidence of violence and aggression and ensure that less detrimental alternatives to restrictive interventions are used.

And wherever possible, people who use services, family carers, advocates and other relevant representatives should be engaged in all aspects of planning their care including how to respond to crisis situations, post-incident debriefings, rigorous reporting arrangements for staff and collation of data regarding the use of restrictive interventions.

Post-incident review - the aim should be to understand from the person’s point of view how the service failed to understand what they needed, what upset them the most, whether staff did anything that was helpful, what staff did wrong, and how things could be better the next time. It is also important to establish whether anything could be done differently to make a restrictive intervention less traumatic.

Local policy frameworks - all policies must be co-produced with people who use services and carers … The policy should explain how people who use services, their carers, families and advocates participate in planning, monitoring and reviewing the use of restrictive interventions and in determining the effectiveness of restrictive intervention reduction programmes. This will include providing accessible updates and publishing key data within quality accounts (or equivalent report).

Paul also discussed The Wellbeing And Recovery Partnership (The WARP)  - getting the skill mix right which is a A partnership between the Dorset Mental Health Forum (DMHF), and NHS Dorset: Dorset Healthcare University NHS Foundation Trust.

The aim of the WaRP is to change the culture of mental health services and people's attitudes to mental health in Dorset through promoting the principles of wellbeing and the philosophy of recovery. Central to this is the partnership between people with lived experience, their supporters and mental health professionals.

"The helping relationship between clinicians and patients moves away from being expert/patient to being 'coaches' or 'partners' on a journey of discovery. Clinicians are there to be 'on tap, not on top‘"


Scroll down to full presentation

Useful Links:
NHS Protect released a series of training videos to complement the ‘Meeting needs and reducing distress’ guidance document, as a tool to assist in challenging behaviour awareness training or as a standalone learning resource for healthcare staff. View the guidance document HERE

New advice for staff on the use of restrictive interventions for patients with difficult behaviour
Positive and Proactive Care: reducing the need for restrictive interventions View here
Positive and Proactive Care: reducing the need for restrictive interventions View here

Events of interest:

Masterclass: The Legal use of Control and Restraint
Tuesday 4 November 2014 London

Out of Hours Care in Hospital
Tuesday 2 December 2014 London

Leading your Organisation to Zero-Harm
Tuesday 9 December 2014 Manchester

Monitoring & Improving Patient Safety
Thursday 11 December 2014 London

Masterclass: The Legal use of Control and Restraint
Wednesday 14 January 2015 London

Patient Safety, Incident Reporting, Investigation & Learning
Monday 2 February 2015 London

Download: Alison Cobb & Paul Scates

23 October 2014


    Partner Organisations

    The Tavistock and Portman NHS Foundation TrustInPracticeClinical Audit Support CentrePlayoutJust For Nurses
    GGI (Good Governance Institute) accredited conferences CPD Member BADS (British Association of Day Surgery) accredited conferences