Positive and Proactive Care aims to reduce reliance on restrictive interventions through cultural change and therapeutic environments. The document discusses reducing the use of seclusion, which should not be used as punishment or due to staff shortages. It provides data showing variation in seclusion rates across mental health services and examines the definition of seclusion in the revised Code of Practice. The Positive and Safe program is building a network of over 300 champions to promote less restrictive practices through training and sharing best practices.
1. 1
Positive and Proactive Care:
reducing the need for restrictive
interventions
Guy Cross – Policy Lead, Positive and Safe, Department of Health
Reducing seclusion
20th October 2015
2. 2
Why focus on reducing restrictive
interventions?
• Human rights
• Injuries to staff
• No one likes restraining service users
• Money
3. 3
Why Positive and Proactive Care?
•Abuse at Winterbourne View
•Subsequent investigations
show that these findings are
widespread
•Transforming Care
Programme
•Mind Freedom of Information
request shows wide variation
in the use of restraint
Reducing the need for restrictive interventions
4. 4
Positive and Proactive Care
Aims
• Cultural change
• Therapeutic environments
• Focus on quality of life
• Governance models
• Reducing reliance on restrictive interventions
• Learning, sharing and promoting practice
innovation
• To ensure that restrictive interventions are used
in a transparent, legal and ethical manner
5. 5
Is my service’s use of seclusion high?
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.0
5.0
10.0
15.0
20.0
25.0
RES039
RES006
RES053
RES007
RES036
RES058
RES051
RES084
RES068
RES066
RES087
RES034
RES077
RES065
RES037
RES052
RES054
RES047
RES067
RES074
RES031
RES038
RES018
RES061
RES025
RES080
RES015
RES029
RES059
RES071
RES064
RES019
RES062
RES023
RES014
RES010
RES083
RES049
RES048
RES076
RES057
RES069
RES001
RES060
RES063
RES075
RES085
Number of incidences of use of seclusion - PICU total - per 10 beds
Values RES087 Mean Lower Quartile Median Upper Quartile
6. 6
Link to use of restraint
0
5
10
15
20
25
30
35
40
45
50
Adult Acute Older Adult PICU Low Secure Medium
Secure
High Secure CAMHS
non-
forensic
CAMHS
forensic
Acute
Admission
beds LD
Low Secure
- LD
Medium
Secure - LD
High Secure
- LD
Restraint and Seclusion per 10 beds
Restraint Seclusion
7. 7
Principles - 2008 Code of Practice
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• Alternative terminology ………should not be used to
deprive patients of the safeguards.
• Seclusion should not be used as a punishment or a
threat, or because of a shortage of staff.
• It should not form part of a treatment programme.
• Seclusion should never be used solely as a means of
managing self-harming behaviour.
• Seclusion of an informal patient should be taken as an
indication of the need to consider formal detention.
8. 8
Why were there changes in the revised
Code of Practice?
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Need for clarity – before the new Code
• it’s only seclusion if it’s in a seclusion room
• It’s only seclusion if we call it seclusion
Reinforce guidance in Positive and Proactive Care
• Aim for less restrictive interventions
The consultation proposals went further than the text now
in the Code of Practice
9. 9
Definition of seclusion
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Seclusion refers to 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 which is likely
to cause harm to others.
10. 10
Does it count as seclusion if?
• The door isn’t locked
• A person prevents the
patient from leaving
the room rather than
a locked door
• Members of the staff
team are caring for
the patient
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11. 11
Positive & Safe - Building a
Network of Champions
•Moving towards 300
champions
•2 national and 2
regional champions’
events
•4 regional culture
change workshops
with FoNS over 300
staff attended
•Monthly newsletters
Positive and Safe
http://www.england.nhs.uk/6cs/gro
ups/positive-safe-
champions/resources/
