Listening to experience, reducing restraint Paul Farmer Chief Executive Mind 27 June 2014 mind.org.uk

About Mind We provide advice and support to empower anyone experiencing a mental health problem We campaign to improve services, raise awareness and promote understanding We work in partnership with over 150 local Minds to provide services tailored to their community People with mental health problems inform everything we do

The road to national guidance Continued lack of ‘definitive guidance’ and nationally accredited training following David ‘Rocky’ Bennett’s death in 1998 and despite further deaths and inquests Winterbourne View Mind’s independent inquiry and crisis care campaign RCN Congress debate and leadership People doing things differently – 6 Core Strategies, No Force First, Safe Wards, Respect …..

Mind’s inquiry “When we think of acute care, do we think of locked wards or someone being held face down? Or is this practice 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

Mind’s campaign “need to change culture and environment…. for support and accredited training for staff… underpinned by respect for service users and involving those who have been at the wrong end of restraint procedures” Dr S P Sashidharan

Mind’s campaign – what we found Incidents of physical restraint Number of respondents: 47 (87 per cent of all trusts) Total: 39,883 Range: Highest 3,346; lowest 38 Median: 455 Face down restraint Number of respondents: 27 (50 per cent of all trusts) Total: 3,439 Range: Highest 923; lowest 0 Latest national figures at

Mind’s campaign – what we found Traumatic experiences Failings in communication and in post-incident review Negative experiences of Black people and local success in campaigning for change Concerns among staff

“Restraint is overused in my experience. Often staff would not bother to try and understand patients - and would just assume they were being irrational or delusional. My partner was treated very roughly when she refused to take medication. This was because she had had bad side effects before and the staff refused to explain what medication she was being given. When I persuaded staff to actually listen to her they eventually sorted it out” [Carer’s quote in evidence to Mind’s inquiry]

I’ve suffered physical abuse when I was younger and being held down where someone forces their weight on you is triggering for me… it’s the last thing that’s going to make me conform; I don’t want them touching me.

Coming out of a psychotic episode is always scary, but the staff were always sure to inform me of what was going on so that I was not confused as to why somebody was holding my arms. They would repeat that I had been trying to hurt myself and they were doing this to protect me until they were sure I had understood.

Mind’s campaign – what we found Initiatives to work differently, for example: o Sheffield Health and Social Care Foundation Trust using RESPECT Training Solutions’ training and techniques o IMROC sites using recovery principles in clinical practice and developing No Force First o Hertfordshire Partnership NHS Foundation Trust’s conflict reduction strategy

Positive and proactive

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.

Positive and proactive – service user engagement 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).

Positive and proactive workforce “All learning should be co-produced”

Listening to experience, reducing restraint The voices of people at Winterbourne View were not heard People with experience of being restrained spoke out in Mind’s campaign People with experience of being restrained successfully influenced their Trust in Sheffield Restraint reduction strategies include peer role and debriefing – and engagement is relevant to all aspects Don’t try to do this without people who have experienced restraint

Any questions? For more information: Visit Contact –