Centre for Perfect Care - No Force First

There is a growing recognition that the use of restrictive interventions in mental health and learning disability environments obstructs recovery and makes people who use the services, and the staff that support them, less safe. No Force First seeks to find new solutions for people in distress through people who use services and the staff who support them working in collaboration. We want to enhance the fantastic work our staff do in supporting recovery and helping people when they are at their most distressed.

Why ‘No Force First?’

There has been historical concern that people in mental health and learning disability environments have not always received the best, most compassionate care at times when they are distressed and potentially challenging. There is a sense that people using these services are not always heard when identifying what helps them at times when they are distressed, frustrated or angry. Traditional work systems and cultures have sometimes prevented staff being able to bring all of their natural compassion and empathy to fraught situations.

The national drive for change

Following scandals of care such as the misuse of physical restraint with vulnerable people with a learning disability at ‘Winterbourne View’ Hospital the Department of Health have published comprehensive national guidance – ‘Positive and Safe’ to support a drive to prevent cultures of abuse in care environments. Mental health and Learning Disability environments are now monitored by healthcare regulators to ensure they have robust plans in place to reduce restrictive interventions like restraint. Here at Mersey Care we felt the need to make changes in advance of national initiatives and made ‘No Force First’ one of our Perfect Care priorities.

Co-production at the core

Within Mersey Care all in-patient units have an introductory No Force First Engagement Session that is fully co-produced by clinical staff and our ‘Experts by Experience’. These are people who have used services and may have had negative experiences of restrictive interventions. It is felt that having staff work with people using our services, as equal partners, sets a clear example of how we need to rebalance power between people providing and using services. These first person accounts of the impact of restrictive interventions on their recovery is critical to winning hearts and minds in order to change practice.

Key Components

Encouraging Innovation – Ward teams are encouraged to develop new ideas to improve the service user experience and reduce conflict. These changes can range from reviewing certain rules, to changing activity programmes, to improving communication channels to people on the unit. These changes are measured for their impact on restrictive interventions
Use of data – Incident figures are analysed in order to identify areas that may need more support in implementing change or areas that are doing well and whose positive practice can be shared with other areas
Risk sharing partnerships – The process encourages greater collaboration with people using services in order to hear what matters to them, with assessment of risk shared between the practitioner and the person using services. Positive risk taking to encourage recovery and reduce conflict is encouraged and celebrated
De-briefing for all – Wherever possible it is essential that people who have experienced restrictive interventions are given the opportunity to talk about the incident, in the same way staff would. This new perspective, can be a critical source of learning in order to provide less restrictive, preventative strategies for the future. Both the people who use services and the staff who are working with them can benefit from this emphasis on mutual support.

We are determined to work with service users, carers, family members and staff to create a culture where physical restraint becomes a thing of the past. We have a comprehensive guide to support the process and we are excited about the positive impact the process is making – with many areas experiencing significant reductions in the use of physical intervention and related reductions in staff sickness / absence. We welcome any ideas around how you feel that we can make this element of Perfect Care a reality.

Resources

No Force First Overview

Contact: Dr Jennifer Kilcoyne, Clinical Director Centre for Perfect Care

Email: jennifer.kilcoyne@merseycare.nhs.uk