Hard Choices, Unheard Voices- Physical Interventions in Mental Health In-Patient Settings

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Hard Choices, Unheard Voices- Physical
Interventions in Mental Health In-Patient Settings

• Clinical Nurse Specialist Security Lead
• PMVA Instructor, Level 2 WLMHT Model (Retired)
• RCN Forensic Nursing Forum
• Committee Member

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Alternative Title

• Unless
• (More later)

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Two Questions to bear in mind

• What are the choices?
• Whose are the voices?

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Resolution to RCN Congress24th April 2013

• That this meeting of RCN Congress asks Council
  to lobby UK governments to review, accredit and
  then regulate national guidelines of approved
  models of physical restraint
• Proposed by the RCN Forensic Nursing Forum
• Seconded by the RCN Older Peoples Nursing Forum
• FOR 470
• AGAINST 1
• ABSTAIN 1

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On Taking a Step Down Position
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Competing NHS Agendas

• Commissioning
• Leadership
• Safeguarding
• Compassion
• Whistleblowing
• And more..

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An emotive hot potato

• Winterbourne
• Mid-Staffs
• Deaths under restraint
• Pain-compliance
• Coercion
• Capacity / empowerment / accountability

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Key Points

• Death under restraint is not a Never Event
• Google
• Approved national standards would be NICE
• Ongoing NICE review
• Current system does not suit all areas
• Its like asking for water to be wet, and ice to
  be cold

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One Trusts Journey
Service PI Model
Forensic Rampton CR
Adult Rampton CR
Older People Rampton CR
Learning Disability Rampton CR
CAMHS TCI
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One Trusts Journey
Service PI Model
Forensic Broadmoor CR
Adult Broadmoor CR
Older People Broadmoor CR
Learning Disability Broadmoor CR
CAMHS TCI
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One Trusts Journey
Service PI Model
Forensic Broadmoor CR
Adult Basis PMVA
Older People SCIP-r
Learning Disability SCIP-r
CAMHS TCI
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One Trusts Journey
Service PI Model
Forensic MAPA
Adult Basis PMVA
Older People SCIP-r
Learning Disability SCIP-r
CAMHS TCI
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One Trusts Journey
Service PI Model
Forensic MAPA
Adult MAPA
Older People MAPA
Learning Disability MAPA
CAMHS MAPA
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It was news to me
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Unless
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My Options Appraisal - 2009

• We use a BILD accredited model

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My Options Appraisal - 2009

• We use a BILD accredited modelunless

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Sheffield Trust

• Prone restraint has been banned in this Trust...

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Sheffield Trust

• Prone restraint has been banned in this
  Trust...unless

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Positive Proactive Care (DoH)

• No pain compliance

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Positive Proactive Care (DoH)

• No pain complianceunless

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Positive Proactive Care (DoH)

• Breakaways must not cause pain

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Positive Proactive Care (DoH)

• Breakaways must not cause painunless

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So we are left with

• Necessary
• Reasonable
• Proportionate
• Positive and Safe comes up with the goods

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Are we any further on?