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PROactive Management of Integrated

Services & Environments

PROGRESS PROCESS PROMOTE PROTECT

PROMISE Charter

Ceri Wilson

Research Associate, PROMISE


Ceri Wilson: Ceri is a Research Associate on the PROMISE project, seconded to CPFT from Anglia Ruskin University. Ceri previously obtained a first class honours degree and a PhD in psychology from Loughborough University. Ceri’s main research interests lie in the promotion of mental health, wellbeing and social inclusion of mental health service users. In her spare time Ceri enjoys playing the guitar and ukulele, and enjoys drawing and painting. She is a proud auntie and loves spending time with her nephew and niece.

PROMISE qualitative strand: mental health patients’ and staff members’ experience of physical intervention, suggestions for reducing its use, and understanding of proactive care.


Introduction: It is estimated that 12% of UK mental health patients have experienced physical intervention (PI), with great variation in its use across NHS Trusts. PI has many negative physical and psychological consequences for patients and staff and is argued to be overused in mental healthcare. New Department of Health guidance (2014) states that PI should only be used as a last resort and services should develop/implement proactive ways of reducing its use.


Methods: Aims: 1) improve understanding of the subjective experience of PI for patients and staff on mental health wards within CPFT; 2) elicit suggestions from patients and staff on how to reduce PI; and 3) explore patient and staff understanding of and views about proactive care. Staff and service user advisory groups provided advice and guidance on all aspects of the study. Semi-structured interviews were conducted with 13 patients who had personal experience of, and/or witnessed, PI during their time as an inpatient on an adult mental health ward within CPFT, and 22 current members of staff (in any job role) with at least one experience of direct involvement in, or witnessing, the PI of a patient on an adult inpatient mental health ward within CPFT.


Preliminary findings: Thematic analysis is ongoing but emerging themes from the patient interviews will be presented. Patients experienced PI as: distressing, dehumanising, a reminder of previous trauma, a loss of control, leading to passive acceptance, and being implemented inconsistently. Patients also reported both good and bad examples of communication before, during and after PI. In order to reduce restraint the importance of good communication between staff and patients was emphasised, as was the importance of patient/staff relationships (with staff needing to get to know patients, be compassionate, and remove the culture of ‘them and us’). The use of environment and space and the introduction and implementation of clear and consistent guidelines was also emphasised. Finally a dominant theme emerging from the patient interviews is the view that restraint is sometimes necessary and cannot be completely eliminated.


Future plans: Thematic analysis of staff interviews is to follow. Findings will be incorporated into a PROMISE toolkit and framework, and will be submitted for publication in peer-reviewed academic journals.