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Nhs relational security presentation-2

The document discusses the development of propositions for a project aimed at reducing serious incidents and escapes in secure mental health services. The first proposition is titled "Empowerment through knowledge" with the strapline "See Think Act." It suggests that to prevent escapes, mental health staff need to understand relational security and know what to look for and do if they see warning signs. Initial design concepts are presented for the "See Think Act" proposition, including infographics explaining the concepts of knowing patient boundaries, preventing incidents, and acting if something seems wrong.

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Show and tell – Friday 30th October 2009 Amy Beeson • Duncan Moss
Relational security… the story so far
Background Relational Security Project team Creative – Amy Beeson & Duncan Moss Account Manager – Gerry McElearney Project Manager – Ben Watson Additional creative input from – Fanny Sigler, Peter Walker and Nicola Humphreys
Background Relational Security Our challenge The main aim of this project is to reduce the number of serious untoward incidents and escapes in secure mental health services and to spread understanding of relational security and the behaviours and actions needed to maintain it.
Background Relational Security Target audience • Ward based staff (qualified and unqualified, including domiciliary staff) in secure mental health settings (NHS and private sector) • Operational managers and clinical leads of secure mental health services (NHS and independent sector) Secondary audiences • Patients • Visitors • Other secure services e.g. prison services • Government • Press
Our client’s biggest fear… “That staff will never look at communications and they’ll end up on the shelf or stuck in a draw.”
Relational Security Stage one Development of propositions
Development of propositions Relational Security Proposition one Empowerment through knowledge If we want mental health staff to see the signs and stop escapes, they need to understand what relational security means. They need to know what to look for and what to do if they see it.
Strapline for proposition one Naming options Relational Security Proposition 1 Proposition 2 Empowerment through knowledge Personal responsibility Be aware be secure Secure thinking, safe working Be aware be alert Security is your responsibility Think safe, work safe Keep everyone safe – [variable message] Aware Alert Act Take responsibility, be aware Secure thinking Say something Know the risks, know the limits See it and say something Know the risks, be aware If you see something say something Stop Think Act You can stop it if you say something Look Think Act Inform Think Act Think Act Stop See Think Act Think Act Prevent See it, Stop it See it, Say it, Stop it Be safe Be secure Be alert and act
Strapline – See Think Act Naming for proposition one Relational Security SEE THINK ACT SEE THINK SEE THINK SEE THINK SEE THINK SEE THINK SEE THINK ACT ACT ACT ACT ACT ACT
Design concepts – proposition one Relational Security nk Act - Approach 1 See Think Act - Approach 1 RELATIONAL SECURITY Understanding how relationships between staff and patients can stop escapes Relational Security SEE THINK ACT You can’t read minds, but you can learn to SEE THINK spot when something ACT isn’t right 13 Lorem ipsum dolor sit amet non iriure Lorem ipsum dolor sit amet, euismod tincidunt ut laoreet Nam liber tempor cum Nam liber tempor cum Know your consectetuer adipiscing elit, dolore magna aliquam erat sed diam nonummy nibh volutpat. option congue nihil option congue nihil patient boundaries euismod tincidunt ut laoreet imperdiet doming id quod. imperdiet doming id quod. dolore magna aliquam erat Ut wisi enim ad minim volutpat. Ut wisi enim ad veniam, quis nostrud exerci Prevent an incident minim veniam, quis nostrud tation ullamcorper suscipit possim assum. possim assum. exerci tation ullamcorper lobortis nisl ut aliquip ex ea amet, consectetuer amet, consectetuer suscipit lobortis nisl ut aliquip commodo consequat. Duis adipiscing elit. adipiscing elit. ex ea commodo consequat. autem vel eum iriure dolor in hendrerit in vulputate velit euismod tincidunt euismod tincidunt Duis autem vel eum iriure esse molestie consequat, vel illum dolore eu feugiat aliquam erat volutpat. aliquam erat volutpat. dolor in hendrerit in vulputate velit esse molestie nulla facilisis at vero eros et accumsan et iusto odio consequat, vel illum dolore et accumsan et iusto odio dignissim qui blandit. eu feugiat nulla facilisis at dignissim qui blandit praesent vero eros et accumsan et luptatum zzril delenit augue delenit augue duis dolore iusto odio dignissim qui duis dolore te feugait nulla te feugait nulla facilisi. blandit praesent luptatum facilisi. zzril delenit augue duis Nam liber tempor cum soluta SEE dolore te feugait nulla facilisi. Lorem ipsum dolor sit amet, nobis eleifend option congue Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse consectetuer adipiscing elit, nihil imperdiet doming id molestie consequat, vel illum dolore eu feugiat nulla facilisis. sed diam nonummy nibh quod mazim placerat facer SEE THINK THINK ACT www.seethinkact.nhs.uk ACT
Design concepts – proposition one Relational Security See Think Act - Approach 2 See Think Act - Approach 2 Nam liber tempor cum Nam liber tempor cum Relational Security imperdiet doming id quod. adipiscing elit. DID YOU SEE THE STOP IT WARNING Relational Security Relational Security SIGNS? HAPPENING lobortis nisl ut aliquip commodo consequat vel eum AGAIN iriure dolor in eum hendrerit Lorem ipsum dolor sit amet, Lorem ipsum dolor sit amet, minim veniam, quis nostrud consectetuer adipiscing elit, consectetuer adipiscing elit, exerci tation ullamcorper sed diam nonummy nibh sed diam nonummy nibh suscipit lobortis nisl ut aliquip euismod tincidunt ut laoreet euismod tincidunt ut laoreet ex ea commodo consequat. dolore magna aliquam erat dolore magna aliquam erat volutpat. Ut wisi enim ad volutpat. Duis autem vel eum iriure minim veniam, quis nostrud dolor in hendrerit in exerci tation ullamcorper Ut wisi enim ad minim vulputate velit esse molestie suscipit lobortis nisl ut aliquip veniam, quis nostrud exerci consequat, vel illum dolore ex ea commodo consequat. tation ullamcorper suscipit eu feugiat nulla facilisis at lobortis nisl ut aliquip ex ea vero eros et accumsan et Duis autem vel eum iriure commodo consequat. Duis iusto odio dignissim qui dolor in hendrerit in autem vel eum iriure dolor in blandit praesent luptatum vulputate velit esse molestie hendrerit in vulputate velit zzril delenit augue duis. consequat, vel illum dolore eu feugiat nulla facilisis at Lorem ipsum dolor sit amet, vero eros et accumsan et consectetuer adipiscing elit, iusto odio dignissim qui sed diam nonummy nibh blandit praesent luptatum euismod tincidunt ut laoreet zzril delenit augue duis dolore magna aliquam erat dolore te feugait nulla facilisi. volutpat. Ut wisi enim ad SEE SEE THINK THINK ACT ACT DID YOU SEE THE DID YOU DID YOU WARNING SEE THE SEE THE SIGNS? WARNING WARNING SIGNS? SIGNS? Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis. SEE Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis. SEE THINK THINK www.seethinkact.nhs.uk ACT www.seethinkact.nhs.uk ACT
Development of propositions Relational Security Proposition two Personal responsibility When we do the same tasks day in day out it’s easy to become complacent; it’s easy to think “that’s not my problem.” But security and safety is everyone’s problem. Staff need to see the signs and behaviours we know lead to escapes. They need to say something every time there is a risk. It’s always better to say something then to keep silent and hope it won’t happen. Relational security is not something that can be ignored.
Naming for proposition two Relational Security Proposition 2 edge Personal responsibility Secure thinking, safe working Security is your responsibility Keep everyone safe – [variable message] Take responsibility, be aware Say something See it and say something If you see something say something You can stop it if you say something
Strapline – Keep everyone safe Naming for proposition two Relational Security Keep everyone safe say something Keep everyone safe tell someone Keep everyone safe act on it Keep everyone safe see the signs Keep everyone safe report it Keep everyone safe do something Keep everyone safe stop it now
Keep everyone safe – Approach 1 Design concepts – proposition two Relational Security 3 Can you see LOREM IPSUM DOLOR SIT AMET the signs? Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, RELATIONAL SECURITY euismod tincidunt ut laoreet lobortis nisl ut aliquip ex ea vel illum dolore eu feugiat dolore magna aliquam erat commodo consequat. Duis nulla facilisis. Why didn’t volutpat. Ut wisi enim ad autem vel eum iriure dolor minim veniam, quis nostrud in hendrerit in vulputate velit esse molestie consequat, Keep everyone safe – Approach 1 exerci tation ullamcorper Nam liber tempor cum suscipit lobortis nisl ut aliquip vel illum dolore eu feugiat ex ea commodo consequat. nulla facilisis at vero eros option congue nihil anyone do et accumsan et iusto odio imperdiet doming id quod. Duis autem vel eum iriure dignissim qui blandit praesent dolor in hendrerit in luptatum zzril delenit augue possim assum. vulputate velit esse molestie duis dolore te feugait nulla consequat, vel illum dolore facilisi. amet, consectetuer something eu feugiat nulla facilisis at adipiscing elit. vero eros et accumsan et Nam liber tempor cum soluta iusto odio dignissim qui nobis eleifend option congue euismod tincidunt blandit praesent luptatum nihil imperdiet doming id quod mazim placerat facer aliquam erat volutpat. zzril delenit augue duis about it? dolore te feugait nulla facilisi. possim assum. Lorem ipsum et accumsan et iusto odio Lorem ipsum dolor sit amet, dolor sit amet, consectetuer dignissim qui blandit. consectetuer adipiscing elit, adipiscing elit, sed diam sed diam nonummy nibh nonummy nibh euismod delenit augue duis dolore euismod tincidunt ut laoreet dolore magna aliquam erat tincidunt ut laoreet dolore magna aliquam erat volutpat. RELATIONAL SECURITY te feugait nulla facilisi. RELA volutpat. Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit You know when something is going on – lobortis nisl ut aliquip ex ea What’s behind like if a patient is using the phone more Yo commodo consequat. than usual. Do you think they are Keep everyone safe report it planning to escape? Don’t walk away, say something…you can stop it before it happens. the smile? Keep everyone safe tell someone bu Everyone deserves to be treated fairly. It’s important that all staff understand their patients and know when Be a something’s up. There’s always a reason why people’s talki behaviour changes – spot it, think about it, talk about it. some Together we can stop escapes. they Lorem ipsum dolor sit amet consectetuer Lorem ip adipiscing elit. Sed diam nonummy nibh adipiscin euismod tincidunt ut laoreet. Keep everyone safe act on it euismod
ryone safe – Approach 2 proposition two Design concepts – Relational Security RELATIONAL SECURITY 50,000 violent incidents take place across NHS mental health everyone Keep safe – Approach 2 units each year. How many did you stop? Keep everyone safe do something 50% 9 10 RELATIONAL SECURITY RELATIONAL SECURITY 13 LOREM IPSUM DOLOR SIT AMET OUT OF in Lorem ipsum dolor sit amet, consectetuer consequat, vel illum dolore eu feugiat Nam liber tempor cum adipiscing elit, sed diam nonummy nibh nulla facilisis at vero eros et accumsan et euismod tincidunt ut laoreet dolore magna iusto odio dignissim qui blandit praesent aliquam erat volutpat. Ut wisi enim ad luptatum zzril delenit augue duis dolore te nihil imperdiet doming id quod. minim veniam, quis nostrud exerci tation feugait nulla facilisi. ullamcorper suscipit lobortis nisl ut aliquip consectetuer adipiscing elit. MENTAL HEALTH STAFF ex ea commodo consequat. Nam liber tempor cum soluta nobis eleifend option congue nihil imperdiet STAFF tincidunt will find themselves in Duis autem vel eum iriure dolor in doming id quod mazim placerat facer hendrerit in vulputate velit esse molestie possim assum. Lorem ipsum dolor sit erat volutpat. consequat, vel illum dolore eu feugiat amet, consectetuer adipiscing elit, sed compromising situations of all staff were involved in nulla facilisis at vero eros et accumsan et diam nonummy nibh euismod tincidunt et iusto odio dignissim qui blandit. iusto odio dignissim qui blandit praesent ut laoreet dolore magna aliquam erat every week. Is that you luptatum zzril delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor volutpat. Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper duis dolore te feugait nulla facilisi. today? a serious incident. Can you sit amet, consectetuer adipiscing elit, sed suscipit lobortis nisl ut aliquip ex ea diam nonummy nibh euismod tincidunt ut commodo consequat. laoreet dolore magna aliquam erat. believe most incidents Duis autem vel eum iriure dolor in hendrerit recognise the signs? Ut wisi enim ad minim veniam, quis in vulputate velit esse molestie consequat, nostrud exerci tation ullamcorper suscipit vel illum dolore eu feugiat nulla facilisis. Keep everyone safe tell someone lobortis nisl ut aliquip ex ea commodo consequat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie can be prevented. Do you? 3 Lorem ipsum dolor sit amet, consectetuer adipiscing elit, Lorem ipsum dolor sit amet, consectetuer adipiscing sed diam nonummy nibh euismod tincidunt ut laoreet elit, sed diam nonummy nibh euismod tincidunt ut dolore magna aliquam erat. Lorem ipsum dolor sit amet, laoreet dolore magna aliquam erat. Lorem ipsum consectetuer adipiscing elit, sed diam nonummy nibh dolor sit amet, consectetuer adipiscing elit, sed diam euismod tincidunt ut laoreet dolore magna aliquam erat. nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat. Lorem ipsum dolor sit amet consectetuer Lorem ipsum dolor sit amet consectetuer adipiscing elit. Sed diam nonummy nibh adipiscing elit. Sed diam nonummy nibh euismod tincidunt ut laoreet. Keep everyone safe act on it euismod tincidunt ut laoreet. Keep everyone safe stop it now
Relational Security Stage two More research
Stage two – research Relational Security We interviewed mental health staff about their understanding of relational security. When we looked at what they said there were some clear themes coming through around the eight areas of relational security… Team Other patients Therapy Boundaries Patient mix Patient dynamic Inconsistent treatment Staff too busy Past histories Whispering/plotting Change in staff Not questioning behaviour Safe place to come Bullying Patient involvement Not knowing the history Involving patients Coercion/trading Agree working approaches Inappropriate relationships New patients arriving Escalating behaviour Staff being singled out Complacency New relationships Change in atmosphere Inside world Outside world Personal world Physical environment Visitors Outward connections Ignoring small changes Putting things together Family visits More telephone calls Seeing the patterns Giving time to patients New visitor added Hanging around exits Asking questions Understanding the risks Change of frequency Wanting medical attention Seeing the risks Raising the alarm Visit from partner Tampering with handles What’s affected them? Handover information Solicitor’s visit Going on leave
Deliverables Relational Security Deliverables Staff told us they wanted the information on relational security to be face to face and interactive. So we began work on… • Posters for areas of relational security • team exercise to explore problems and solutions • Handbook to give more information • Training materials • Promotional materials
RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY Spot the difference? You hear it, but are What’s behind you listening? the smile? It’s easy to take things at face value. But noticing You know when something doesn’t sound right. small changes in patients will give you clues about You know when something’s up. There’s always a It might be the smallest thing but it’s always better what’s really going on in their lives. It’s time to reason why someone’s behaviour changes. Spot it, to say something than do nothing. find out what’s behind the change. think about it, talk about it. Together we can keep people safe. relational security relational security relational security Your guide to Your guide to Your guide to Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, your guide to your guide to your guide to relational security. Keep everyone safe act on it relational security. Keep everyone safe act on it relational security. Keep everyone safe act on it RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY Crossed the line? Said too much? Playing by the rules? Stop… have you It’s good to see you! Can you see the signs? passed it on? Visits can make a big difference to patients. Think We all deserve to be treated fairly. Rules are about the impact you might have on the person It’s easy to say too much when we get chatting, there to keep you safe. If you know that you’re visiting. If there’s something staff need to but giving patients personal information puts you someone is breaking the rules, you can help At the end of the shift, we all just want to get home. know, say something before you go. You know when something is going on – like if at risk. If things have gone too far, now’s the time put a stop to it – just say something. But when you rush it’s easy to forget about those a patient is using the phone more than usual. Bending the rules for a patient just that once can to get back on track. small things that tell us something is wrong. Stop. It’s time to ask yourself why? Don’t walk away, be an easy thing to do but a hard place to get back from. If things have gone too far, now’s the You need to pass everything on before you go. say something... you can stop it before it happens. time to get back on track. Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, your guide to your guide to your guide to your guide to your guide to your guide to relational security. Keep everyone safe stop it now relational security. Keep everyone safe stop it now relational security. Keep everyone safe act on it relational security. Keep everyone safe act on it relational security. Keep everyone safe report it relational security. Keep everyone safe report it
Training wheel Relational Security OT HE M R A ix PA tm TE Th TI en EN era ti TS py Pa Bo un nt dar tie mic ies Pa n a dy PATIENT RATING SCALE OT HE R 10 Extremel ard M Per A ix tw n s PA tm TE w o s ona Th Ou tio TI 9 en EN era rld l ti TS nec py Pa Bo un nt 8 on tie ic dar c ies Pa n a m dy Ph iron 7 rs en OU ito ysi PATIENT D 6 v RL TS Vis cal ent ard Per tw wo sona Ou tions 5 O ID ec rld l n con m W W E Ph iron s E 4 en OU r O ito ysi D D v RL SI RL TS Vis cal ent O ID D 3 IN m W W E O DE RL D SI IN 2 1 No confid
Handbook Relational Security Team 01 Therapy…what you need to know Understanding the use of therapy in relational security 01 The importance Relational security is one of the of therapy and clear Therapy should give patients hope and belief in their most important elements in ensuring therapeutic progress. own recovery. Staff must understand the care and treatment Therapy is based on trust, which 02 02 patient boundaries each patient needs and the risks involved. in the secure mental health environment can be difficult to create. Patient T’s story Patient T became isolated from all working with staff to recover. Patient Lack of knowledge about a the staff on the ward. When new T responded by singling out the new patient and no clear plan about OT For you to maintain relational security there 03 During Patient T’s first two years on members of clinical or domestic nurse with extremely aggressive how to manage change will 03 the ward she had a good relationship staff came onto the ward she behaviour. The new nurse challenged escalate behaviour. Without staff M HE R needs to be trust between patients and staff. with only one member of staff, would single them out and taunt Patient T and asked why was she working together to create a A who she talked to about what was them with aggressive behaviour. behaving like this, and said did Patient ix Every member of staff who has regular contact more positive relationship PA tm TE happening in her life. But she didn’t Staff didn’t have a consistent T realise it was this behaviour that there is no way for a situation Th TI with patients whether they are clinical or want this information to be shared approach to this and it was left to was stopping her getting leave for the en to improve and it will just get EN era with anyone else. So when the individual members of staff to cope weekend. Patient T responded to this ti 04 worse and worse. 04 TS py Pa Bo domestic has an impact on patients’ lives, trusted staff member left, Patient T in their own way. Some would avoid by becoming withdrawn and quiet. un nt felt abandoned and refused to talk to her and others became frustrated in Staff left her to it, and hoped she had Developing therapeutic dar tie ic care and recovery. That means every member ies Pa nam anyone else. being unable to find out what was “learnt her lesson.” That weekend the relationships is an important part of dy behind her behaviour and gave up on new nurse was attacked by Patient T of staff has a part to play in understanding trying to gain Patient T’s trust. during the nightshift. relational security. The benefits of Staff didn’t talk about therapy include better management PATIENT and actively supporting relational security. 05 Patient T’s treatment. of violence and improvement in 05 Everyone treated her in Staff were not in control the patients’ responses to change and intervention. ard Per a different way and she of the situation. They tw w o s ona Within your team there are two aspects of Ou tions rld l didn’t talk about changes Staff must work together across nec made no improvement. con relational security to explore they are therapy in Patient T’s behaviour the team to see the individual Ph iron and what needs of patients and give them rs 06 06 en OU and boundaries. This chapter will give you the During the months that followed, ito ysi the opportunity to say how D was behind it. v there were times when she would RL TS Vis cal ent their care could be managed. information to build on your knowledge of suddenly become aggressive and O ID When there are good therapeutic m W W staff didn’t know what E A new nurse started work on the O DE these areas to help you keep everyone safe. had triggered this behaviour relationships on the ward it helps RL SI ward in the same week Patient T’s do you feel to provide a safe place where D IN or the best way to deal with it. How confident d? friend got a leave of absence. y on your war patients’ treatment plans are 07 Patient T said she saw no point in her about therap 07 r next team understood and followed. treatment and that she had Patient T wanted leave as well but Discuss at you -to-one. no belief in her own recovery. was refused because she was not meeting or one 08 08 What you can do RELATIONAL SECURITY 01 01 Steps you can take to improve patient therapy Evaluate how well you are doing You can take action to Encouraging patients to believe You know you are getting therapy right when… What’s behind improve relational security through therapy by: in their own recovery and helping them to see what they can do to improve Both staff and patients understand how the ward should be and how we deal with any issues. 02 the smile? 02 Planning how to manage Being consistent and caring Patients take part in therapy and social activities. transition and change in treatment of patients Patients have hope and want to recover. Being a positive role model Helping patient recovery in 03 03 Patients know what they need to do to progress and recover. and setting a good example everything you do (therapy shouldn’t just happen in the We know that even small changes, can have an impact on patients, Engaging with patients and treatment room!) so we talk to them about how they feel and manage any change. making a commitment to their treatment Helping patients prepare for We look for opportunities to reinforce therapy in everything experiences with the outside we do with patients. 04 04 world Patients feel connected and prepared to go out into the community. It’s easy to take things at face value. But noticing What else could you and your team do small changes in patients will give you clues about to improve things? Add in your own ideas for how you want to see what’s really going on in their lives. It’s time to 05 05 your ward change… find out what’s behind the change. Keep everyone safe act on it 06 06 07 Remember to take your handbook with you to any 07 staff meetings on relational security so you can record your thoughts and individual actions. 08 08
Outcome Relational Security Next steps • Test new version of tool • Complete and test handbook • Develop training materials • Develop promotional materials
Relational Security Thank you. Any questions?

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Nhs relational security presentation-2

  • 1.
    Show and tell– Friday 30th October 2009 Amy Beeson • Duncan Moss
  • 2.
    Relational security… the story so far
  • 3.
    Background Relational Security Project team Creative – Amy Beeson & Duncan Moss Account Manager – Gerry McElearney Project Manager – Ben Watson Additional creative input from – Fanny Sigler, Peter Walker and Nicola Humphreys
  • 4.
    Background Relational Security Our challenge The main aim of this project is to reduce the number of serious untoward incidents and escapes in secure mental health services and to spread understanding of relational security and the behaviours and actions needed to maintain it.
  • 5.
    Background Relational Security Target audience • Ward based staff (qualified and unqualified, including domiciliary staff) in secure mental health settings (NHS and private sector) • Operational managers and clinical leads of secure mental health services (NHS and independent sector) Secondary audiences • Patients • Visitors • Other secure services e.g. prison services • Government • Press
  • 6.
    Our client’s biggestfear… “That staff will never look at communications and they’ll end up on the shelf or stuck in a draw.”
  • 7.
  • 8.
    Development of propositions Relational Security Proposition one Empowerment through knowledge If we want mental health staff to see the signs and stop escapes, they need to understand what relational security means. They need to know what to look for and what to do if they see it.
  • 9.
    Strapline for propositionone Naming options Relational Security Proposition 1 Proposition 2 Empowerment through knowledge Personal responsibility Be aware be secure Secure thinking, safe working Be aware be alert Security is your responsibility Think safe, work safe Keep everyone safe – [variable message] Aware Alert Act Take responsibility, be aware Secure thinking Say something Know the risks, know the limits See it and say something Know the risks, be aware If you see something say something Stop Think Act You can stop it if you say something Look Think Act Inform Think Act Think Act Stop See Think Act Think Act Prevent See it, Stop it See it, Say it, Stop it Be safe Be secure Be alert and act
  • 10.
    Strapline – SeeThink Act Naming for proposition one Relational Security SEE THINK ACT SEE THINK SEE THINK SEE THINK SEE THINK SEE THINK SEE THINK ACT ACT ACT ACT ACT ACT
  • 11.
    Design concepts –proposition one Relational Security nk Act - Approach 1 See Think Act - Approach 1 RELATIONAL SECURITY Understanding how relationships between staff and patients can stop escapes Relational Security SEE THINK ACT You can’t read minds, but you can learn to SEE THINK spot when something ACT isn’t right 13 Lorem ipsum dolor sit amet non iriure Lorem ipsum dolor sit amet, euismod tincidunt ut laoreet Nam liber tempor cum Nam liber tempor cum Know your consectetuer adipiscing elit, dolore magna aliquam erat sed diam nonummy nibh volutpat. option congue nihil option congue nihil patient boundaries euismod tincidunt ut laoreet imperdiet doming id quod. imperdiet doming id quod. dolore magna aliquam erat Ut wisi enim ad minim volutpat. Ut wisi enim ad veniam, quis nostrud exerci Prevent an incident minim veniam, quis nostrud tation ullamcorper suscipit possim assum. possim assum. exerci tation ullamcorper lobortis nisl ut aliquip ex ea amet, consectetuer amet, consectetuer suscipit lobortis nisl ut aliquip commodo consequat. Duis adipiscing elit. adipiscing elit. ex ea commodo consequat. autem vel eum iriure dolor in hendrerit in vulputate velit euismod tincidunt euismod tincidunt Duis autem vel eum iriure esse molestie consequat, vel illum dolore eu feugiat aliquam erat volutpat. aliquam erat volutpat. dolor in hendrerit in vulputate velit esse molestie nulla facilisis at vero eros et accumsan et iusto odio consequat, vel illum dolore et accumsan et iusto odio dignissim qui blandit. eu feugiat nulla facilisis at dignissim qui blandit praesent vero eros et accumsan et luptatum zzril delenit augue delenit augue duis dolore iusto odio dignissim qui duis dolore te feugait nulla te feugait nulla facilisi. blandit praesent luptatum facilisi. zzril delenit augue duis Nam liber tempor cum soluta SEE dolore te feugait nulla facilisi. Lorem ipsum dolor sit amet, nobis eleifend option congue Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse consectetuer adipiscing elit, nihil imperdiet doming id molestie consequat, vel illum dolore eu feugiat nulla facilisis. sed diam nonummy nibh quod mazim placerat facer SEE THINK THINK ACT www.seethinkact.nhs.uk ACT
  • 12.
    Design concepts –proposition one Relational Security See Think Act - Approach 2 See Think Act - Approach 2 Nam liber tempor cum Nam liber tempor cum Relational Security imperdiet doming id quod. adipiscing elit. DID YOU SEE THE STOP IT WARNING Relational Security Relational Security SIGNS? HAPPENING lobortis nisl ut aliquip commodo consequat vel eum AGAIN iriure dolor in eum hendrerit Lorem ipsum dolor sit amet, Lorem ipsum dolor sit amet, minim veniam, quis nostrud consectetuer adipiscing elit, consectetuer adipiscing elit, exerci tation ullamcorper sed diam nonummy nibh sed diam nonummy nibh suscipit lobortis nisl ut aliquip euismod tincidunt ut laoreet euismod tincidunt ut laoreet ex ea commodo consequat. dolore magna aliquam erat dolore magna aliquam erat volutpat. Ut wisi enim ad volutpat. Duis autem vel eum iriure minim veniam, quis nostrud dolor in hendrerit in exerci tation ullamcorper Ut wisi enim ad minim vulputate velit esse molestie suscipit lobortis nisl ut aliquip veniam, quis nostrud exerci consequat, vel illum dolore ex ea commodo consequat. tation ullamcorper suscipit eu feugiat nulla facilisis at lobortis nisl ut aliquip ex ea vero eros et accumsan et Duis autem vel eum iriure commodo consequat. Duis iusto odio dignissim qui dolor in hendrerit in autem vel eum iriure dolor in blandit praesent luptatum vulputate velit esse molestie hendrerit in vulputate velit zzril delenit augue duis. consequat, vel illum dolore eu feugiat nulla facilisis at Lorem ipsum dolor sit amet, vero eros et accumsan et consectetuer adipiscing elit, iusto odio dignissim qui sed diam nonummy nibh blandit praesent luptatum euismod tincidunt ut laoreet zzril delenit augue duis dolore magna aliquam erat dolore te feugait nulla facilisi. volutpat. Ut wisi enim ad SEE SEE THINK THINK ACT ACT DID YOU SEE THE DID YOU DID YOU WARNING SEE THE SEE THE SIGNS? WARNING WARNING SIGNS? SIGNS? Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis. SEE Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis. SEE THINK THINK www.seethinkact.nhs.uk ACT www.seethinkact.nhs.uk ACT
  • 13.
    Development of propositions Relational Security Proposition two Personal responsibility When we do the same tasks day in day out it’s easy to become complacent; it’s easy to think “that’s not my problem.” But security and safety is everyone’s problem. Staff need to see the signs and behaviours we know lead to escapes. They need to say something every time there is a risk. It’s always better to say something then to keep silent and hope it won’t happen. Relational security is not something that can be ignored.
  • 14.
    Naming for propositiontwo Relational Security Proposition 2 edge Personal responsibility Secure thinking, safe working Security is your responsibility Keep everyone safe – [variable message] Take responsibility, be aware Say something See it and say something If you see something say something You can stop it if you say something
  • 15.
    Strapline – Keepeveryone safe Naming for proposition two Relational Security Keep everyone safe say something Keep everyone safe tell someone Keep everyone safe act on it Keep everyone safe see the signs Keep everyone safe report it Keep everyone safe do something Keep everyone safe stop it now
  • 16.
    Keep everyone safe– Approach 1 Design concepts – proposition two Relational Security 3 Can you see LOREM IPSUM DOLOR SIT AMET the signs? Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, RELATIONAL SECURITY euismod tincidunt ut laoreet lobortis nisl ut aliquip ex ea vel illum dolore eu feugiat dolore magna aliquam erat commodo consequat. Duis nulla facilisis. Why didn’t volutpat. Ut wisi enim ad autem vel eum iriure dolor minim veniam, quis nostrud in hendrerit in vulputate velit esse molestie consequat, Keep everyone safe – Approach 1 exerci tation ullamcorper Nam liber tempor cum suscipit lobortis nisl ut aliquip vel illum dolore eu feugiat ex ea commodo consequat. nulla facilisis at vero eros option congue nihil anyone do et accumsan et iusto odio imperdiet doming id quod. Duis autem vel eum iriure dignissim qui blandit praesent dolor in hendrerit in luptatum zzril delenit augue possim assum. vulputate velit esse molestie duis dolore te feugait nulla consequat, vel illum dolore facilisi. amet, consectetuer something eu feugiat nulla facilisis at adipiscing elit. vero eros et accumsan et Nam liber tempor cum soluta iusto odio dignissim qui nobis eleifend option congue euismod tincidunt blandit praesent luptatum nihil imperdiet doming id quod mazim placerat facer aliquam erat volutpat. zzril delenit augue duis about it? dolore te feugait nulla facilisi. possim assum. Lorem ipsum et accumsan et iusto odio Lorem ipsum dolor sit amet, dolor sit amet, consectetuer dignissim qui blandit. consectetuer adipiscing elit, adipiscing elit, sed diam sed diam nonummy nibh nonummy nibh euismod delenit augue duis dolore euismod tincidunt ut laoreet dolore magna aliquam erat tincidunt ut laoreet dolore magna aliquam erat volutpat. RELATIONAL SECURITY te feugait nulla facilisi. RELA volutpat. Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit You know when something is going on – lobortis nisl ut aliquip ex ea What’s behind like if a patient is using the phone more Yo commodo consequat. than usual. Do you think they are Keep everyone safe report it planning to escape? Don’t walk away, say something…you can stop it before it happens. the smile? Keep everyone safe tell someone bu Everyone deserves to be treated fairly. It’s important that all staff understand their patients and know when Be a something’s up. There’s always a reason why people’s talki behaviour changes – spot it, think about it, talk about it. some Together we can stop escapes. they Lorem ipsum dolor sit amet consectetuer Lorem ip adipiscing elit. Sed diam nonummy nibh adipiscin euismod tincidunt ut laoreet. Keep everyone safe act on it euismod
  • 17.
    ryone safe –Approach 2 proposition two Design concepts – Relational Security RELATIONAL SECURITY 50,000 violent incidents take place across NHS mental health everyone Keep safe – Approach 2 units each year. How many did you stop? Keep everyone safe do something 50% 9 10 RELATIONAL SECURITY RELATIONAL SECURITY 13 LOREM IPSUM DOLOR SIT AMET OUT OF in Lorem ipsum dolor sit amet, consectetuer consequat, vel illum dolore eu feugiat Nam liber tempor cum adipiscing elit, sed diam nonummy nibh nulla facilisis at vero eros et accumsan et euismod tincidunt ut laoreet dolore magna iusto odio dignissim qui blandit praesent aliquam erat volutpat. Ut wisi enim ad luptatum zzril delenit augue duis dolore te nihil imperdiet doming id quod. minim veniam, quis nostrud exerci tation feugait nulla facilisi. ullamcorper suscipit lobortis nisl ut aliquip consectetuer adipiscing elit. MENTAL HEALTH STAFF ex ea commodo consequat. Nam liber tempor cum soluta nobis eleifend option congue nihil imperdiet STAFF tincidunt will find themselves in Duis autem vel eum iriure dolor in doming id quod mazim placerat facer hendrerit in vulputate velit esse molestie possim assum. Lorem ipsum dolor sit erat volutpat. consequat, vel illum dolore eu feugiat amet, consectetuer adipiscing elit, sed compromising situations of all staff were involved in nulla facilisis at vero eros et accumsan et diam nonummy nibh euismod tincidunt et iusto odio dignissim qui blandit. iusto odio dignissim qui blandit praesent ut laoreet dolore magna aliquam erat every week. Is that you luptatum zzril delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor volutpat. Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper duis dolore te feugait nulla facilisi. today? a serious incident. Can you sit amet, consectetuer adipiscing elit, sed suscipit lobortis nisl ut aliquip ex ea diam nonummy nibh euismod tincidunt ut commodo consequat. laoreet dolore magna aliquam erat. believe most incidents Duis autem vel eum iriure dolor in hendrerit recognise the signs? Ut wisi enim ad minim veniam, quis in vulputate velit esse molestie consequat, nostrud exerci tation ullamcorper suscipit vel illum dolore eu feugiat nulla facilisis. Keep everyone safe tell someone lobortis nisl ut aliquip ex ea commodo consequat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie can be prevented. Do you? 3 Lorem ipsum dolor sit amet, consectetuer adipiscing elit, Lorem ipsum dolor sit amet, consectetuer adipiscing sed diam nonummy nibh euismod tincidunt ut laoreet elit, sed diam nonummy nibh euismod tincidunt ut dolore magna aliquam erat. Lorem ipsum dolor sit amet, laoreet dolore magna aliquam erat. Lorem ipsum consectetuer adipiscing elit, sed diam nonummy nibh dolor sit amet, consectetuer adipiscing elit, sed diam euismod tincidunt ut laoreet dolore magna aliquam erat. nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat. Lorem ipsum dolor sit amet consectetuer Lorem ipsum dolor sit amet consectetuer adipiscing elit. Sed diam nonummy nibh adipiscing elit. Sed diam nonummy nibh euismod tincidunt ut laoreet. Keep everyone safe act on it euismod tincidunt ut laoreet. Keep everyone safe stop it now
  • 18.
  • 19.
    Stage two –research Relational Security We interviewed mental health staff about their understanding of relational security. When we looked at what they said there were some clear themes coming through around the eight areas of relational security… Team Other patients Therapy Boundaries Patient mix Patient dynamic Inconsistent treatment Staff too busy Past histories Whispering/plotting Change in staff Not questioning behaviour Safe place to come Bullying Patient involvement Not knowing the history Involving patients Coercion/trading Agree working approaches Inappropriate relationships New patients arriving Escalating behaviour Staff being singled out Complacency New relationships Change in atmosphere Inside world Outside world Personal world Physical environment Visitors Outward connections Ignoring small changes Putting things together Family visits More telephone calls Seeing the patterns Giving time to patients New visitor added Hanging around exits Asking questions Understanding the risks Change of frequency Wanting medical attention Seeing the risks Raising the alarm Visit from partner Tampering with handles What’s affected them? Handover information Solicitor’s visit Going on leave
  • 20.
    Deliverables Relational Security Deliverables Staff told us they wanted the information on relational security to be face to face and interactive. So we began work on… • Posters for areas of relational security • team exercise to explore problems and solutions • Handbook to give more information • Training materials • Promotional materials
  • 21.
    RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY Spot the difference? You hear it, but are What’s behind you listening? the smile? It’s easy to take things at face value. But noticing You know when something doesn’t sound right. small changes in patients will give you clues about You know when something’s up. There’s always a It might be the smallest thing but it’s always better what’s really going on in their lives. It’s time to reason why someone’s behaviour changes. Spot it, to say something than do nothing. find out what’s behind the change. think about it, talk about it. Together we can keep people safe. relational security relational security relational security Your guide to Your guide to Your guide to Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, your guide to your guide to your guide to relational security. Keep everyone safe act on it relational security. Keep everyone safe act on it relational security. Keep everyone safe act on it RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY RELATIONAL SECURITY Crossed the line? Said too much? Playing by the rules? Stop… have you It’s good to see you! Can you see the signs? passed it on? Visits can make a big difference to patients. Think We all deserve to be treated fairly. Rules are about the impact you might have on the person It’s easy to say too much when we get chatting, there to keep you safe. If you know that you’re visiting. If there’s something staff need to but giving patients personal information puts you someone is breaking the rules, you can help At the end of the shift, we all just want to get home. know, say something before you go. You know when something is going on – like if at risk. If things have gone too far, now’s the time put a stop to it – just say something. But when you rush it’s easy to forget about those a patient is using the phone more than usual. Bending the rules for a patient just that once can to get back on track. small things that tell us something is wrong. Stop. It’s time to ask yourself why? Don’t walk away, be an easy thing to do but a hard place to get back from. If things have gone too far, now’s the You need to pass everything on before you go. say something... you can stop it before it happens. time to get back on track. Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, Read SEE THINK ACT, your guide to your guide to your guide to your guide to your guide to your guide to relational security. Keep everyone safe stop it now relational security. Keep everyone safe stop it now relational security. Keep everyone safe act on it relational security. Keep everyone safe act on it relational security. Keep everyone safe report it relational security. Keep everyone safe report it
  • 22.
    Training wheel Relational Security OT HE M R A ix PA tm TE Th TI en EN era ti TS py Pa Bo un nt dar tie mic ies Pa n a dy PATIENT RATING SCALE OT HE R 10 Extremel ard M Per A ix tw n s PA tm TE w o s ona Th Ou tio TI 9 en EN era rld l ti TS nec py Pa Bo un nt 8 on tie ic dar c ies Pa n a m dy Ph iron 7 rs en OU ito ysi PATIENT D 6 v RL TS Vis cal ent ard Per tw wo sona Ou tions 5 O ID ec rld l n con m W W E Ph iron s E 4 en OU r O ito ysi D D v RL SI RL TS Vis cal ent O ID D 3 IN m W W E O DE RL D SI IN 2 1 No confid
  • 23.
    Handbook Relational Security Team 01 Therapy…what you need to know Understanding the use of therapy in relational security 01 The importance Relational security is one of the of therapy and clear Therapy should give patients hope and belief in their most important elements in ensuring therapeutic progress. own recovery. Staff must understand the care and treatment Therapy is based on trust, which 02 02 patient boundaries each patient needs and the risks involved. in the secure mental health environment can be difficult to create. Patient T’s story Patient T became isolated from all working with staff to recover. Patient Lack of knowledge about a the staff on the ward. When new T responded by singling out the new patient and no clear plan about OT For you to maintain relational security there 03 During Patient T’s first two years on members of clinical or domestic nurse with extremely aggressive how to manage change will 03 the ward she had a good relationship staff came onto the ward she behaviour. The new nurse challenged escalate behaviour. Without staff M HE R needs to be trust between patients and staff. with only one member of staff, would single them out and taunt Patient T and asked why was she working together to create a A who she talked to about what was them with aggressive behaviour. behaving like this, and said did Patient ix Every member of staff who has regular contact more positive relationship PA tm TE happening in her life. But she didn’t Staff didn’t have a consistent T realise it was this behaviour that there is no way for a situation Th TI with patients whether they are clinical or want this information to be shared approach to this and it was left to was stopping her getting leave for the en to improve and it will just get EN era with anyone else. So when the individual members of staff to cope weekend. Patient T responded to this ti 04 worse and worse. 04 TS py Pa Bo domestic has an impact on patients’ lives, trusted staff member left, Patient T in their own way. Some would avoid by becoming withdrawn and quiet. un nt felt abandoned and refused to talk to her and others became frustrated in Staff left her to it, and hoped she had Developing therapeutic dar tie ic care and recovery. That means every member ies Pa nam anyone else. being unable to find out what was “learnt her lesson.” That weekend the relationships is an important part of dy behind her behaviour and gave up on new nurse was attacked by Patient T of staff has a part to play in understanding trying to gain Patient T’s trust. during the nightshift. relational security. The benefits of Staff didn’t talk about therapy include better management PATIENT and actively supporting relational security. 05 Patient T’s treatment. of violence and improvement in 05 Everyone treated her in Staff were not in control the patients’ responses to change and intervention. ard Per a different way and she of the situation. They tw w o s ona Within your team there are two aspects of Ou tions rld l didn’t talk about changes Staff must work together across nec made no improvement. con relational security to explore they are therapy in Patient T’s behaviour the team to see the individual Ph iron and what needs of patients and give them rs 06 06 en OU and boundaries. This chapter will give you the During the months that followed, ito ysi the opportunity to say how D was behind it. v there were times when she would RL TS Vis cal ent their care could be managed. information to build on your knowledge of suddenly become aggressive and O ID When there are good therapeutic m W W staff didn’t know what E A new nurse started work on the O DE these areas to help you keep everyone safe. had triggered this behaviour relationships on the ward it helps RL SI ward in the same week Patient T’s do you feel to provide a safe place where D IN or the best way to deal with it. How confident d? friend got a leave of absence. y on your war patients’ treatment plans are 07 Patient T said she saw no point in her about therap 07 r next team understood and followed. treatment and that she had Patient T wanted leave as well but Discuss at you -to-one. no belief in her own recovery. was refused because she was not meeting or one 08 08 What you can do RELATIONAL SECURITY 01 01 Steps you can take to improve patient therapy Evaluate how well you are doing You can take action to Encouraging patients to believe You know you are getting therapy right when… What’s behind improve relational security through therapy by: in their own recovery and helping them to see what they can do to improve Both staff and patients understand how the ward should be and how we deal with any issues. 02 the smile? 02 Planning how to manage Being consistent and caring Patients take part in therapy and social activities. transition and change in treatment of patients Patients have hope and want to recover. Being a positive role model Helping patient recovery in 03 03 Patients know what they need to do to progress and recover. and setting a good example everything you do (therapy shouldn’t just happen in the We know that even small changes, can have an impact on patients, Engaging with patients and treatment room!) so we talk to them about how they feel and manage any change. making a commitment to their treatment Helping patients prepare for We look for opportunities to reinforce therapy in everything experiences with the outside we do with patients. 04 04 world Patients feel connected and prepared to go out into the community. It’s easy to take things at face value. But noticing What else could you and your team do small changes in patients will give you clues about to improve things? Add in your own ideas for how you want to see what’s really going on in their lives. It’s time to 05 05 your ward change… find out what’s behind the change. Keep everyone safe act on it 06 06 07 Remember to take your handbook with you to any 07 staff meetings on relational security so you can record your thoughts and individual actions. 08 08
  • 24.
    Outcome Relational Security Next steps • Test new version of tool • Complete and test handbook • Develop training materials • Develop promotional materials
  • 25.