Written and recorded by Steph Barber
hello. Welcome to this data loss session in relation to mental health on the Mental Health Act, 1983 has amended My name's Steph Barber on I'm From Law Hound Limited. I'm a former solicitor on guy, was previously a member off the Law Society's accredited Mental Health Review Tribunal panel. In this session, we're considering treatment for mental disorder on the safe and therapeutic culture on responses to adult disturbed behaviour. In the session will be looking at what are restrictive intervention reduction programs, the importance of assessment each individual primary, secondary and tertiary strategies for disturbed behaviour, and measuring the success of restrictive intervention reduction programs primarily within the session. We're looking at issues insofar as they relate to those age 16 on over on their special considerations. When looking at the under sixteens, let's examine the concept of creating a safe and therapeutic culture. Mental health care providers and of course, those involved in the broader therapeutic program in health and social care need to provide for people with disturbed behaviour, and that's irrespective off the age on whether there actually detained under the Mental Health Act or MH A. Those who make percent a particular risk to themselves or to others, including their caregivers. It's generally accepted by health care providers that there may, unfortunately be occasions as a last resort, when restrictive interventions are unavoidable on by restrictive interventions. I mean interventions such as enhanced observation, physical restraint, mechanical restraint, rapid, tranquil ization seclusion on the long term segregation. However, the Department of Health, in its code of practice to the Mental Health Act or the code, aims to reduce the use of restrictive intervention on the basis that a safe and therapeutic culture should be provided for all people receiving treatment for a mental disorder, including those who may present with behavioral disturbance. Therefore, the code does make it very clear that providers on those in the broader therapeutic program in health and social care must have a firm and robust restrictive intervention reduction program to manage people with disturbed behaviour, including those who present a risk to themselves or others. So what are restrictive intervention reduction programs? The code views restrictive intervention reduction programs as overarching multi component action plans, applying to all people receiving treatment from mental disorder in a hospital and who are liable to percent with behavioral disturbances regardless of their age or issues such as well as their detained on the yet no notes. The code advocates that programmes should include policies and guidance which provide a clear definition off restrictive intervention. With guidance on particular types of restrictive interventions on the particular needs of Children and young people, the program should define roles and responsibilities. Andi include appropriate staff training programs. Also need to clarify the importance of the individual ONDA, the risk assessments and use of positive behavior. Support plans to meet support needs and aimed rent behavioral disturbances by promoting early recognition on de escalation on understanding factors which influence behavior factors such as poorly treated symptoms of mental disorder, unmet social, emotional or health needs. Excessive stimulation, noise in general destruction, even excessive heating overcrowding on restricted access to external space. Other factors which can influence behavior include boredom, lack of constructive things to do, insufficient environmental stimulation, lack of clear communication by staff with patients or excessive or unreasonable application of demands and rules, and the general lack off positive social interaction or restricted or unpredictable access to preferred items on day activities. It's also about understanding the patient's feelings that others are not concerned with their subject active anxieties and concerns, or that when they're being exposed to situations that mirror past traumatic experiences and create a sense of personal disempowerment or emotional distress, it's about understanding that frustrations associated with being in the district and controlling environment on inconsistent care. Andi, even physical influence have on the role that can need to disturbed behaviour, and so programmes clearly need to engage service users in the serving planning. Andi EVALUATION ANDI Accepting that restrictive intervention reduction programs might be a last resort, the code wants service providers to clearly show how those intervention should be authorized. Initiated, applied, reviewed on discontinued on. Also alongside that how the patient might be supported throughout the duration of the application of any form of restrict of intervention on that means service providers having clear training and guidance relating to the application of restrictive interventions which are underpinned by therapeutic intent. And it also means having accountability for showing how lessons are learned following the use of restrictive interventions but accountability for continual improvements in service quality through the delivery of positive Andi proactive care, it means service providers having governance arrangements to demonstrate that all reasonable steps have been taken, prevent the misuse miss application off restrictive interventions and that there are appropriate recording on reporting mechanisms. All of this is to reduce the use of restrictive interventions on, instead, promote a positive aunt therapeutic culture on set very clear goals for improvements and keep providing a safe in therapeutic culture. It's the assessment off individual concerns. Assessing the potential risks off behavioural disturbance on the assessment needs to take place at the earliest possible opportunity, such as on admission to hospital where a person can be assessed for immediate on potential risks. Off behavioural disturbance assessments need to be individualized and therefore must take into account fact. It is such a C persons history off behaviors, but without assuming that the person will always behave in the same way they need to take account of the history of experiencing personal trauma on their presenting mental and physical state. The assessments also need to consider their current social circumstances on seek to understand behavior in its broader context. Taking into account the individuals social and physical environment on DNA, always pursue that behavior is in fact a manifestation off mental disorder assessments need professional import particularly when those professionals are alert two risks that may not be immediately apparent. Such a self neglect comprehensive assessments will also consider the views of patients, their families, carers and advocates regarding the behavior to help gain insight regarding individual responses to behavior that have Bean tried in the past on assessments must avoid negative and stigmatizing judgments about certain diagnosis, behaviors or personal characteristics so that they don't obscure a rigorous assessment off the degree of risk which might be presented, or the potential benefits off appropriate treatment to people who assessed as liable 2% with behavioral disturbances. And that means that the results off a comprehensive individual assessments should guide the development and implementation off effective, personalized and enduring systems of support that actually meet the individual's needs on promote recovery. A swell as enhancing the quality of life outcomes both for the individual on others who care and support, Um concluded individual assessments should describe behaviors off concern, identify factors which predict their occurrence on describe the functions that behaviors serve or the outcomes there. Chief of the individuals, including primary, secondary and tertiary strategies on the assessment should be included with the patients, plum for care be that a care plan, a care programme, approach C p A or a positive behavior support plan or whatever is the equivalent. And of course, it also means individual assessments should be reviewed on. Also, assessments generally need to be audited for accuracy. And, of course, they're actually achieving what they set out to do. Tertiary strategies need to be there to guide stuff and cares when there is a behavioral disturbance on responses to behavioral disturbance. Need to be individualized and wide ranging, including continued attempts to de escalate the situation. Summoning assistance, removing sources of environmental stress or removing potential targets for aggression from the area. If appropriate, and so restrictive interventions need to be a very last resort on only when they're unavoidable on the code requires that they should be planned, evidence based lawful in the patient's best interests, proportionate and dignified. That means that they're there when medically necessary. In all the circumstances of the case on, they are unnecessary on proportionate response to the actual behavioral disturbance. Restrictive interventions should minimize distress and risk of harms the patient on never ever be used to deliberately punish or humiliate, and this includes staff, not causing deliberate pain in an attempt to force compliance with their instructions, except in the very most exceptional circumstances. To mitigate on immediate risk to life. Restrictive intervention must be preplanned. Andi have one single member off staff, assuming control of the instant on ensuring that they're only used in a way that respects human rights and a consistent with current national policy and best practice guidance. Restrictive intervention must be very much based on individual assessments as well as care plans or treatment plans, which have included the primary and secondary stuff strategies. First of all, any restrictive intervention that is Eudes needs to be recorded in what the code describe is an open and transparent manner detail ing the nature and manner off the restrictive intervention, the reasons for its use on the consequences or outcome. And it must be about taking a robust approach to ensuring that restrictive intervention is used in the safest possible manner on dis Regularly reviewed. Andi updated In line with this, the code also provides guidelines for each type of restricted intervention. So, for example, when using physical restraints so guidelines in relation to physical restraints savory clearly, for example, that there should never be any impact on airways or breathing or circulation. Onda must always take into account the individual's own circumstances, such as their age or physical and emotional maturity on their health status together, of course, with any disability or sensory impairments. And it's all about checking the additional risks to health, safety and well, being on very, very clearly restrictive intervention should be a very last resort. One thing we do also have to bear in mind that with certain restrictive interventions, there may be other considerations. For example, patients who are subject to a Ministry of Justice order maybe on occasions required to be mechanically restrained, including by handcuffs for security purposes particularly, for example, when transferring prisoners into ah healthcare environments. Or, of course, we may have the transfer off restricted patients who are normally in a secure setting, too, a non secure setting. And even in those circumstances, it's recommended that mechanical restraints should be considered by first of all, undertaking on assessment of the risks posed by the patient as well as their presenting physical Andi mental condition on the need to maximize their dignity. Onda whilst it is, of course, the duty on any escorting stuff to alert medical staff about any risks in relation to removing restraints. Normally, if the medical stuff requests removal off restraint while carrying out a medical treatment, then that request would normally be honored. So how is the success off restrictive intervention reduction programs actually measured? Well, it's fairly straightforward, actually. Recode views key indicators that restrictive intervention reduction programs are being properly delivered as including a reduction in the use of restrictive interventions, a reduction of injuries as a result of any restrictive interventions, naturally improved patient satisfaction and, of course, reduced complaints. And of course, all of this is very much in line with the aim off, creating a safe and therapeutic culture on making sure that restrictive intervention is very much a last resort on. One document you might be interested in looking at is from the Royal College of Nursing, and it is available from their website. It was published in June 2000 and 17. Ondas called three steps to positive practice. The document examines restrictive intervention. Andi makes the point that providing health care involves embedding the delivery of care, treatment and services in a rights based approach which places the person at the center of everything that is done. The document encourages practitioners to recognize that whilst radical change is off to need it, it's about evolution rather than revolution. And it's hoped that the three steps to positive practice will help structure nursing care. Andi, they're thinking as decisions are made, which can have a major impact on the lives of people who use services, so ensuring that humanity and compassion remains central to the care and support that is provided the Royal College of Nursing conclude that this is their responsibility every time that now brings this current mental health session to an end. Thank you very much for joining me, Steph Barber on this Data Law mental health session.
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