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Like-minded organisations in pursuit of restraint-free services

A Compassionate Intervention for Problematic Organisational Cultures

jo-varelaGuest blogger, Jo Varela, discusses the idea of ‘culture change’ as an integral part of reducing restraint in services and provides an insight into what to expect during her workshop on the Thursday afternoon of this year’s Restraint Reduction Conference.

Restraint has been in the news again. A Freedom of Information Act request by Norman Lamb revealed that the number of restraints and face down restraints had increased rather than decreased since the introduction of the Positive and Safe initiative.

The aims of the initiative are clear and unambiguous. We would struggle to meet staff or patients who would not sign up to these aims wholeheartedly. So why do we still restrain, and why is it so hard, after two years, to evidence the initiative’s impact in some areas?

In an interview with the BBC, Paul Farmer of the charity MIND suggested that culture needed addressing in those organisations that were not responding well to the aims set out by the initiative. Culture is a tricky thing to understand and change. Leadership (one of the six core strategies) is key to setting an organisational culture through clear vision and values; however, explicit interventions for ‘culture change’ remain elusive. The Positive and Safe initiative calls for wholesale change in mental health care, yet as we know, ‘Culture eats change for breakfast’.

‘Culture’ has been a familiar factor in a number of inquiries into problems in care, indeed the Francis Report states that ‘The Inquiry has heard a great deal about culture as the explanation for many of the deficiencies existing at the Trust’. Professor John Glasby told the Francis inquiry: ‘The trouble with culture is everyone blames it when things go wrong but no-one really knows what it is or how to change it’.

Culture can be defined as a ‘shared set of basic assumptions, the way a group learns to perceive, think and cope in relation to problems, and how they pass these beliefs to new members of a group’. As such, it can be understood using models of human thought, feeling, behaviour and relationships. Cognitive Analytic Therapy is one such model.

Myself and Phil Clayton are offering a workshop on how to use the Cognitive Analytic Therapy (CAT) model to help organisations ‘map’ problematic cultures and understand their relationship and behaviours towards to clients at risk of restraint. The model can be used to help organisations understand the stresses and strains that lead them to respond to challenging behaviour in unhelpful ways. Jo and Phil will show how CAT can be used to work at a number of levels in the system; to understand, predict and prevent challenging behaviour from individuals; to understand team and leadership dynamics that get in the way of good patient care.

The workshop will offer a brief introduction to the CAT approach and give case examples of CAT-informed interventions that have demonstrated a positive influence on restraint. The approach aims to work collaboratively with staff and patients to offer a compassionate understanding and way forward. CAT interventions support staff to actively engage their therapeutic values and skills even if they are afraid, stuck or stressed, acknowledging that demonising staff and services is unhelpful and stigmatising.

Phil Clayton is a UKCP Registered CAT psychotherapist and Jo Varela is  a Consultant Psychologist and accredited Cognitive Analytic Therapy Practitioner and both work with people with challenging behaviour. Using a CAT approach they have worked in community, acute and forensic settings with teams in distress to reduce challenging behaviour and restrictive practice. Phil Clayton is co-editor of a book on Cognitive Analytic Therapy and contributed a chapter on using the approach in a therapeutic forensic community. Jo Varela contributed a chapter on working with challenging behaviour using a CAT approach.