Restrictive practices are things that limit the rights of a person, like being able to move around freely. Restrictive practices are meant to be only used as a last resort and to stop people from doing behaviours of concern. The restrictive practices which are used within secure mental health settings such as Cheswold Park Hospital include restraint, seclusion, long term segregation, rapid tranquilisation and mechanical restraint. Please see the information leaflets co-produced with patients to explain each further.
The importance of reducing restrictive practices in mental health settings is an issue of national importance. Positive and Proactive Care (Department of Health, 2014) states that mental health services have the duty to reduce restrictive interventions and must have a senior lead reporting to the trust board who is accountable for taking this forward. Within Cheswold Park Hospital, Dr Charlotte Caton (Director of Clinical Services) is the Chair of the Reducing Restrictive Practices Committee. She provides feedback to Rick Fuller (Nursing & Operations Director) who is the Executive Sponsor of the committee, responsible for providing feedback to the board.
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Use of Force Act 2018
This is new legislation for mental health units in England. In 2010, Olaseni (Seni) Lewis died aged 23 after being restrained on a mental health ward by police officers. At the inquest, the restraint was deemed to be excessive, unreasonable and disproportionate. Following his death, a bill was proposed that would make organisations legally accountable for ensuring the use of force is minimised, reported and effectively reviewed. ‘Seni’s Law’ The Mental Health Units (Use of Force) Act received
Royal ascent in 2018
Under the new act, use of force includes physical, mechanical or chemical restraint of a patient or the isolation of a patient (which includes seclusion and segregation). The act defines the different types of force as;
Physical restraint: the use of physical contact that is intended to prevent, restrict or subdue movement of any part of the patient’s body. This would include holding a patient to give them a depot injection.
Mechanical restraint: the use of a device that is intended to prevent, restrict or subdue movement of any part of the patient’s body, and is for the primary purpose of behavioural control. Examples would include handcuffs or a ‘body cuff’.
Chemical restraint: the use of medication that is intended to prevent, restrict or subdue movement of any part of the patient’s body. This includes the use of rapid tranquillisation.
The act states that isolation is any seclusion or segregation that is imposed on a patient, however it does not define these terms. The definitions of these are defined in Annex A of the Mental Health Act 1983: Code of Practice, which applies to any patient in a mental health unit detained under that act, as:
Seclusion: the supervised confinement and isolation of a patient, away from other patients, in an area from which the patient is prevented from leaving, where it is of immediate necessity for the purpose of the containment of severe behavioural disturbance that is likely to cause harm to others. This can include seclusion where the door to a room is open, but the patient is still prevented from leaving, for example, by a staff member either in or next to the doorway
(Long-term) segregation: a situation where, in order to reduce a sustained risk of harm posed by the patient to others, which is a constant feature of their presentation, a multidisciplinary review and representative from the responsible commissioning authority determines that a patient should not be allowed to mix freely with other patients on the ward on a long-term basis
The requirements set out in the act are:
Section 2 – mental health service providers operating a mental health unit to appoint a ‘responsible person’ who will be accountable for ensuring the requirements in the act are carried out.
Section 3 – the responsible person for each mental health unit must publish a policy regarding the use of force by staff who work in that unit. The written policy will set out the steps that the unit is taking to reduce (and minimise) the use of force by staff who work in the unit.
Section 4 – the responsible person for each mental health unit must publish information for patients about their rights in relation to the use of force by staff who work in that unit.
Section 5 – the responsible person for each mental health unit must ensure staff receive appropriate training in the use of force. This statutory guidance sets out what that training should cover.
Section 6 – the responsible person for each mental health unit must keep records of any use of force on a patient by staff who work in that unit, which includes demographic data across the protected characteristics in the Equality Act 2010.
Section 7 – the Secretary of State for Health and Social Care must ensure that, at the end of each year, statistics are published regarding the use of force by staff, using the relevant information recorded under section 6.
Section 8 – the Secretary of State for Health and Social Care must conduct an annual review of any reports made under paragraph 7 of schedule 5 to the Coroners and Justice Act 2009, and may conduct a review of any other findings or determinations made relating to the death of a patient as a result of the use of force in a mental health unit. The Secretary of State for Health and Social Care must then publish a report that includes conclusions arising from the review.
Section 9 – if a patient dies or suffers serious injury in a mental health unit, the responsible person must have regard to any relevant guidance relating to investigations of deaths or serious injuries.
Section 10 – explains that the responsible person may delegate their functions where appropriate to do so.
Section 11 – the Secretary of State for Health and Social Care must publish guidance that sets out in more detail how to implement the requirements of the act.
Section 12 – if a police officer is going into a mental health unit on duty to assist staff who work in that unit, the police officer must wear and operate a body camera at all times when reasonably practicable.
The act applies to all patients being assessed or treated for a mental health disorder in a mental health unit. This applies equally to both NHS and independent hospitals providing NHS-funded care. For independent hospitals providing NHS-funded care, the act applies to all patients in their care, not just those who are receiving treatment through NHS-funded services. The act also applies whether a patient is detained under the Mental Health Act 1983, or as an informal or voluntary patient.