In 2015, the Mental Health Act Code of Practice called on mental health services to reduce restrictive interventions. These practices are used with mental health and learning disability inpatients at times when there is a risk of harm.
Restrictive practices include physical restraint, seclusion, and rapid tranquilisation. They also extend to wider practices such as preventing a patient from accessing outdoor space.
Research has shown that restrictive practices can cause physical and mental harm to patients and staff. They can also damage the therapeutic relationship between patients and staff.
The State of care in mental health services 2014-2017 report found that there is a significant variation in the way restrictive practices are being used when responding to challenging situations. The report highlighted concerns that care for some patients is overly restrictive.
The Department of Health and Social Care’s Mental Health Units (Use of Force) Act 2018 statutory guidance of 2021 reports that there is still work to do.
The Use of Force Act came into being after a young black man, Olaseni Lewis, died as a result of a restraint whilst using mental health services. The Act aims to provide an opportunity to embed a consistent approach across services nationally. It encourages a trauma-informed way of working where the use of force is an uncommon experience for patients and staff.
The Mental Health Safety Improvement Programme (MHSIP) delivers the core changes described within this Act; ‘changes to promote positive ward cultures that support recovery, engender trust between patients and staff, and protect the safety and wellbeing of all our patients and people using our mental health services.’ (Department of Health and Social Care, 2021).
Led by NHS England and delivered by regional, AHSN-hosted, Patient Safety Collaboratives (PSCs), the programme will continue to scale up and spread the reducing restrictive practice package. The package was developed for the MHSIP by the National Collaborating Centre for Mental Health (NCCMH) in a national reducing restrictive practice pilot group. MHSIP supports the NHS England Patient Safety Strategy.
Aim: Improve safety by reducing harm caused to people using mental health, learning disabilities and autism in-patient services by 2023.
Objectives: To contribute to the programme’s aim, the PSCs will focus on creating safer in-patient mental health and learning disability and autism services by using a systematic quality improvement approach to reduce restrictive practices.
Key ambitions: Reduce restrictive practice in mental health, learning disabilities and autism in-patient services by testing and scaling the reducing restrictive practice (RRP) change package.