The Trust has committed to delivering care in the least restrictive way possible for all our service users. This has particular implications within our inpatient wards, where sometimes movement and activity of our service users is restricted because of their legal status such as detention under the Mental Health Act.
To support this ethos the Trust has a Least Restrictive Practice Group (LPR). The purpose of the group is to lead a Trust Wide approach within mental health and learning disability services to Least Restrictive Practice and its application in practice. This is to ensure that the approaches in practice are in line with the Trusts Quality Strategy around least restrictive practices and harm reduction.
The main functions of the group are described as:
- Leading on the development and review of a Least Restrictive Practice Policy and Training Needs Analysis (incorporating procedures and pathways as relevant).
- Overseeing and continue to apply the workaround the REsTRAIN yourself project and the Self-Injury Pathway including review of these as required.
- Receiving assurance through performance data and serious incident reporting, that the introduction of least restrictive practice strategies are having a positive impact within the Trust.
- Measuring the impact of reducing restrictive practice strategies and take action to improve outcomes by commissioning bespoke audits and/or task and finish groups to undertake work when areas of concern have been raised.
The Mental Health Act Code of Practice (2015) describes restrictive intervention as follows:
'Restrictive interventions are deliberate acts on the part of other person(s) that restrict a patient's movement, liberty and/or freedom to act independently in order to: Take immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is undertaken, and end or reduce significantly the danger to the patient or others'
The LRP Group has developed a positive behaviour framework which supports the use of least restrictive practices. This is currently being consulted on with the wider leadership team in respect of the skill mix and training needed to support its use. Some areas are already using the advocated approaches such as the self-injury pathway, REsTRAIN and RAID. We will keep this page updated as things progress.
The RAID approach is a positive behaviour support model which uses behavioural psychology principles. It is an evidence based model for people who present with extreme behaviours, eg violence, active passivity, deliberate self-harm, severe self-neglect. The approach is a whole team approach for the MDT. The overarching philosophy is that providing relentless therapeutic interventions aimed at teaching services users safe and effective ways of coping overrides the need for extreme behaviour. The principles of the model guide staff to respond to both positive and unhelpful behaviour in the most effective manner. RAID stands for Reinforce Appropriate and Implode Disruptive, which essentially means that adaptive behaviour, is stimulated, promoted, noticed, and reinforced by staff, whilst problem behaviour is downplayed as far as safety and care allow. Both staff and service users are expected to reflect on incidents of problem behaviour to develop their skills and diminish the need for problem behaviour. The approach is consistent with least restrictive principles and complies with Proactive and Safe guidance published by the Department of Health in 2014.
- Basic grounding mindfulness
- Coniston safety planning training
- Distraction and self-soothing checklist
- Distraction and self-soothing evaluation
- Distraction skills
- Effective safety planning
- Grounding - introduction and exercises
- My safety plan
- My safety plan guidance
- Problem solving handouts
- Self-soothing skills
- Urge surfing introduction and exercises
- Wise mind explanatory material