Restrictive Intervention

Hello. Welcome to this mental health floor training session from Data Law. My name's Steph Barber. Andi. I'm from law hounds. I'm a retired solicitor, and I was previously a member off the Law society's specialist mental health law panel. In this session, we're going to be looking at restrictive intervention, and we should be looking at what is restrictive intervention. Restrictive interventions, safeguards, individual needs and assessments, unplanned, restrictive intervention. We're going to be looking at the issues insofar as they relate to those aged 16 and over. Because there are special considerations when looking at those under 16. What is restrictive intervention in the guidance? Positive and proactive care. Reducing the need for restrictive interventions provided by the Department of Health, which I will refer to as the guide. Restrictive interventions are defined as deliberate tax on the part of other persons that restrict an individual's movement, liberty on door freedom to act independently in order to take immediate control off a dangerous situation where there's a really possibility off harm to that person or others. If no action is undertaken, Andi end or reduce significantly the danger to the person or others on contain or limit the person's freedom for no longer than is necessary. The Department of Health's Code of Practice to the Mental Health Act 1983 which I'll refer to as the code, provides further information as to the types off restrictive intervention, which include physical intervention, which is described as any direct physical contact where the interveners intention is to prevent, restrict or subdue movement of the body or part of the body off another person. Mechanical intervention, which is when the device is used to prevent, restrict or subdue movement of a person's body or any part of it in order to control their behavior. Chemical intervention, which is described as the use of medication to calm or likely sedate an individual to reduce the risk of harm to self or others on reduce agitation and aggression. One form is rapid, tranquil ization where medication is prescribed on administered for the purpose of controlling or subduing disturbed violent behavior rather than for treatment of a formally identified physical or mental illness and seclusion, which is described in the code as the supervised confinements and isolation of a patient away from other patients in an area from which the patient is prevented from leaving where it is off. Immediate necessity for the purpose off containment off severe behavioural disturbance, which is likely to cause harm to others. And finally, segregation, which is described in the code as a situation where, in order to reduce a sustained risk of harm posed by the patient to others, a patient is not allowed to mix freely with other patients on the ward or unit on the long term basis. So let's examine restrictive intervention safeguards. Let's have a statutory basis. First of all, restrictive intervention is often a balance between protecting the patient. On recognizing that health care professionals may need to use reasonable force to protect themselves or others from a physical attack, legislation such as the Human Rights Act sets vital principles to protect individuals from abuse by public organizations on those who work within them. And it is, of course, a criminal offence to use physical or threatened to use physical force unless the circumstances give rise to a lawful excuse or justification for its use. As the guide goes on to say, without a clear ethical basis and appropriate safeguards, such acts may be unlawful and judgments asked the acceptability on the GIs Embassy off restrictive interventions will always be based on all presenting circumstances. So what specific guidance is there? While the guide which relates to all restrictive intervention, is aimed promoting best practice principles to ensure the restrictive interventions are used in a transparent legal and ethical manner, and it has six principles which underpin it, firstly, compliance with the relevant rights in the European Convention on Human Rights at all times. Secondly, understanding people's behavior allows the unique needs, aspirations, experiences on strengths to be recognized on their quality of life to be enhanced. Thirdly, involvement and participation of people with care and support needs their families, carers and advocates is essential on wherever practicable on subject to the persons wishes on confidentiality obligations. Fourthly, people must be treated with compassion, dignity and kindness. Firstly, health and social care services must support people to balance safety from harm and freedom of choice. And finally, positive relationships between the people who deliver services on the people they support must be protected and preserved. The code, which specifically relates to mental health, has five guiding principles which should be considered when making all decisions in relation to care, support or treatment provided under the Mental Health Act and the guiding principles are the least restrictive option and maximizing independence, empowerment and involvement, respect and dignity, purpose and effectiveness, and efficiency and equity. Ondas, the code explains. Treatment must be appropriate to a patient's condition and take account off their wishes. All patients, including those who may present with behavioural disturbance, should receive treatment in a safe and therapeutic environment, and guidance is given for providers. Professionals on practitioners on the particular issues related to managing disturbed behaviour, which may present a risk to the patient off others and any restrictive interventions. So, for example, restraint, seclusion or segregation must be undertaken only in a manner that is compliance with human rights. Nice. The National Institute for Health Care Excellence have also issued guidance for the use of restrictive interventions, which they say must only be used if de escalation on other preventive strategies, including PR and medication, have failed. Andi there is potential for harm to the service user or other people. If no action is taken, Nice confirms that healthcare professionals should ensure that techniques and methods used to restrict are proportionate to the risk on potential seriousness of harm are the least restrictive option to meet. The need are used for no longer than necessary. Take account of the service users preferences. If known. Andi, it's possible to do so and take account off. The service uses physical health degree of frailty on developmental age on the code confirms that using restrictive intervention must be planned. Evidence based mournful in the patient's interest, proportionate and dignified. And there's a last resort restrictive intervention reduction program. The code makes it plain that every relevant health care provider must therefore have a restrictive intervention reduction program, which is a serious of policies and guidance. Provide a clear definition off restrictive intervention on guidance on its use in accordance with the code. The policies should include guidance on assessments of risks and support, needs the use of positive behavior support plans or equivalent how the risks associated with restrictive intervention can be minimized and in particular on assessment off their potential to cause harm to the physical, emotional and psychological well being of patients. On how providers will take account off a patient individual vulnerabilities the harm, such as their unique needs associated with physical and emotional maturity. Old age disability poor physical health, pregnancy, past history of traumatic abuse, etcetera and how restrictive interventions which are used by the provider should be authorized, initiated, applied, reviewed and discontinued, as well as how the patient should be supported throughout the duration off the application off that restrictive intervention. And they also need to be guidance about local recording ANDI reporting mechanisms around the use off restrictive intervention, including post incident analysis of briefing and workforce development, including training requirements relating to the application of restrictive interventions which are underpinned by the therapeutic intense so that's examined. Assessing any restrictive intervention program requires an assessment of the individual on the immediate and potential risks of behavioral disturbance to ensure that the system of support is put in place, which meets that individual's needs. The code advocates that on admission to hospital patients suffering for a mental disorder should be assessed for immediate and potential risks of behavioural disturbance by stuff who are alert to risks. That may not be immediately a parent's such a self neglect. As the code explains, assessments should include any history of behavioural disturbance, whilst not assuming that the previous history off behavioural disturbance means that a person will necessarily behave in the same way in the future. Non discriminatory Andi ensure that negative and stigmatizing judgments about certain diagnosis, behaviors or personal characteristics do not obscure a rigorous assessment off the degree of risk which may be presented, or the potential benefits of appropriate treatment to people who are assessed is liable to present with behavioural disturbance. Assessments also need to consider the individual social and physical environment and take into account the views of the patients, their families, carers and advocates, both with regard to why a patient may present with behavioral disturbance on any additional information on assessments should identify factors which may contribute to behavioural disturbance, including poorly treated symptoms of mental disorder, excessive stimulation, noise and general destruction, inconsistent care on the influence of alcohol or drugs, as the code specifies. It's also important that anyone who is identified as being at risk of presenting with behavioural disturbance should be given the opportunity to have their wishes and feelings recorded in an advance statement. If they have the capacity to do so and only once an assessment has been done, can a care programme approach or its equivalent planning be developed and implemented to meet the patients individual leads, however, the plan, of course, must be subject to very regular review so that the system of support continues to meet that individual's needs. So let's examine planned restrictive intervention while care plan should normally involve a three tier strategy. Firstly, primary preventive strategies aimed to enhance a patient's quality of life on meet their unique needs by reducing the likelihood off behavioral disturbances in the first place. So, if you like taking away or minimizing the likelihood off the behavior happening and then secondary preventive strategies which need to focus on recognition of early signs of impending behavioral disturbance on how to respond to them in order to encourage the patient to be calm, including de escalation strategies, de escalation is the gradual resolution off a potentially violent or aggressive situation where an individual begins to show signs of agitation on door arousal that may indicate an impending episode off behavioural disturbance. It relies on liaising with individuals who no the individual well and taking clinical assessments into account de escalation strategy should promote relaxation, such as using verbal and physical expressions of empathy and alliance on be tailored to an individual's needs. and typically involve establishing report on the need for mutual cooperation. Demonstrating compassion, negotiating realistic options, asking open questions, demonstrating concern. Onda attentiveness, using empathetic and nonjudgmental listening destructing. Redirecting the individuals into alternate pleasurable activities. Removing sources off excessive environmental stimulation on being sensitive to nonverbal communications. Finally, to take care not to exacerbate matters by, for example, failing to actors agreed in response to requests or delays in meeting the needs and tertiary strategies. If restrictive interventions are unavoidable than the code requires, they should be planned evidence based lawful in the patient's interest, proportionate and dignified on be medical necessity to do so in all circumstances. The case, as well as being in necessary and proportionate response to the behavioural disturbance on the minimize, distress and risk of harms the patient on, did never be used to deliberately punish or humiliate On. This includes staff not causing deliberate pain in an attempt to force compliance with their instructions except in the most exceptional circumstances to mitigate on immediate risk toe life. They also need to be pre planned on with one single member staff assuming control of the incident and only be used in a way that respects human rights on consistent with current national policy on, of course, best practice guidance, and it must be based on individualized assessment, a swell as care plans or treatment plans, which include primary, secondary and then tertiary strategies on in some services. Such care plans are referred to as positive behavior support or PBS. Plans and strategies must re recorded in an open and transparent manner detail ing the nature and manner of application of any restrictive intervention. The reasons for its use on the consequence or outcome. Andi. It can only be part of a restrictive intervention reduction programme which includes policies, guidance and training, which takes a robust approach to ensuring that they are used in safest possible manner. Onda regularly reviewed on and updated which restrictive intervention should be used as the code makes plain the choice and nature off. Restricted intervention will depend on various factors, but should be guided by the patient's wishes and feelings. If known, for example, by an advance statement what is necessary to meet the needs of the individuals based on current assessment on the history, the patient's age and any individual, physical or emotional vulnerabilities that would increase the risk of trauma arising from specific forms of restrictive interventions on whether a particular form of restrictive intervention would be more likely to cause distress, humiliation or fear and obligations to others affected by the behavioral disturbance on responsibilities to protect all the patients, visitors and staff on finally, the availability off resources in the environment of care. However, any initial attempt to manage an acute behavioural disturbance should assess faras. The situation allows be non restrictive. As the code summarizes, restrictive interventions should not be used to punish or for the sole intention off inflicting pain, suffering or humiliation. They should not be used for longer than necessary to prevent harm to the person or others on be a proportionate response that harm and be the least restrictive option. And that brings us to the end of this session on thank you for joining me, Steph Barber.