Recommendation 33

HM Government Not Addressed

The Government is considering this recommendation. Within specialised commissioning, there are a number of programmes of work to reduce restrictive practice. The national Quality Improvement Taskforce for Children and Young People’s Mental Health, Learning disability and Autism Inpatient Services has a workstream dedicated to reducing restrictive interventions and hosts the national Restrictive Practices Oversight Group. Working in collaboration with the Restraint Reduction11 Network, the taskforce has delivered several projects including: • the development of a suite of documentation and tools by the Restraint Reduction Network to help people (staff, families and inpatients) understand blanket restrictions and their impact on all parties whilst identifying improvements that can be made relatively quickly to move services safely to more individualised care; and • the publication of de-brief guidance and best practice. Kings College London has been commissioned by the Taskforce to deliver the SafeWards programme to 20 inpatient wards across the NHS and Independent sector. Ward leads will receive information, planning and support to implement the ten core interventions until July 2022 with follow- up support provided until December 2022. A seclusion and long-term segregation policy is currently being drafted by the Taskforce. This is supported by the patient safety programme and clinical reference group. Quality improvement programmes will support data collection as well supporting services directly to implement change ideas and to share examples of good practice. We understand that the use of restraint, and particularly prone restraint, can be a frightening and traumatic experience for any child or young person. However, we must also recognise that there may be rare occasions where staff will need to use prone restraint – for example, to stop someone from harming themselves or others – but this should always be used as a last resort and for the shortest time possible. The Mental Health Units (Use of Force) Act, also known as Seni’s Law received Royal Assent in November 2018 and we published commencement regulations on 7 December 2021.The purpose of the Act is to establish the measures that are needed to both reduce the inappropriate use of force and to ensure accountability and transparent about the use of force in mental health units. The act applies to both children and young people and adults. On 7 December 2021, we published the statutory guidance12 on the use of force in mental health settings and the government response to the consultation on the guidance.13 The majority of the provisions within the Act will be brought into force on 31 March 2022 and the rest are expected to be brought into force in May 2022. The Act is part of the Government’s wider reform agenda to improve support for individuals with severe mental illnesses. The Mental Health Act 1983: Code of Practice sets out the following in relation to physical restraint where restrictive intervention is required: Patients should not be deliberately restrained in a way that impacts on their airway, breathing or circulation. The mouth and/or nose should never be covered there should be no pressure to the neck region, rib cage and/or abdomen unless there are cogent reasons for doing so, there must be no planned or intentional restraint of a person in a prone position (whereby they are forcibly laid on their front) on any surface, not just the floor. (Paragraph 26.70) In addition, Positive and Proactive Care 2014: reducing the need for restrictive interventions states: • If exceptionally a person is restrained unintentionally in a prone or face down position, staff should either release their holds or reposition into a safer alternative, as soon as possible; • Staff must not use physical restraint or breakaway techniques that involve the use of pain, including holds where movement by the individual induces pain, other than for the purpose of an immediate rescue in a life-threatening situation.