Hard Choices, Unheard VoicesPhysical 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
Alternative Title
Unless……
(More later……)
Two Questions to bear in mind…
• What are the choices?
• Whose are the voices?
Resolution to RCN Congress
24th 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 People’s Nursing Forum
• FOR 470
• AGAINST 1
• ABSTAIN 1
On Taking a ‘Step Down’ Position
“Competing” NHS Agendas
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•
•
•
•
•
Commissioning
Leadership
Safeguarding
Compassion
Whistleblowing
And more…..
An emotive “hot potato”
•
•
•
•
•
•
Winterbourne
Mid-Staffs
Deaths under restraint
Pain-compliance
Coercion
Capacity / empowerment / accountability
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
It’s like asking for water to be wet, and ice to
be cold…
One Trust’s Journey
Service
PI Model
Forensic
Rampton C&R
Adult
Rampton C&R
Older People
Rampton C&R
Learning Disability
Rampton C&R
CAMHS
TCI
One Trust’s Journey
Service
PI Model
Forensic
Broadmoor C&R
Adult
Broadmoor C&R
Older People
Broadmoor C&R
Learning Disability
Broadmoor C&R
CAMHS
TCI
One Trust’s Journey
Service
PI Model
Forensic
Broadmoor C&R
Adult
Basis PMVA
Older People
SCIP-r
Learning Disability
SCIP-r
CAMHS
TCI
One Trust’s Journey
Service
PI Model
Forensic
MAPA
Adult
Basis PMVA
Older People
SCIP-r
Learning Disability
SCIP-r
CAMHS
TCI
One Trust’s Journey
Service
PI Model
Forensic
MAPA
Adult
MAPA
Older People
MAPA
Learning Disability
MAPA
CAMHS
MAPA
It was news to me…
Unless…
My Options Appraisal - 2009
• We use a BILD accredited model…
My Options Appraisal - 2009
• We use a BILD accredited model…unless…
Sheffield Trust
• Prone restraint has been banned in this
Trust...
Sheffield Trust
• Prone restraint has been banned in this
Trust...unless…
Positive & Proactive Care (DoH)
• No pain compliance…
Positive & Proactive Care (DoH)
• No pain compliance…unless…
Positive & Proactive Care (DoH)
• Breakaways must not cause pain…
Positive & Proactive Care (DoH)
• Breakaways must not cause pain…unless…
So we are left with
• Necessary
• Reasonable
• Proportionate
• “Positive and Safe” comes up with the goods
Are we any further on?