Positive Cultures and Relational Working: a look back

Our annual conference was held in Bristol on 3-4 October, bringing together people with lived experience, family-carers, practitioners, researchers and professionals.

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The two-day hybrid event incorporated a range of keynote speakers and practical workshops with the theme of Positive Cultures and Relational Working prominent throughout. The powerful presentations and workshops demonstrated the importance of cultures emphasising dignity, respect, empathy, and connection. We would like to thank all our speakers, workshop hosts, chairs and delegates for all their contributions to the event.

Day one of the conference opened with a screening of ‘Our Declaration of Independence’ by North Wales Together. The film was introduced by Nicholas Bettis, author Alicia Gough and co-Chair of the North Wales Together Board Shell Williams. This fantastic short film was made over Zoom and states its purpose “To declare independence and free will. To access all the joys and pitfalls of a real life rather than a service life.”

‘Blinding us with science or merely baffling us with bull***t?’ from Sam Sly, consultant at Enough is Enough and Kieran Murphy, Director of Together All Are Able highlighted the ways in which language is often used to obscure or overcomplicate care. They invited delegates to play ‘bull***t bingo’ throughout the day, paying attention to the language they and others used. When looking at the words used to explain care to people supported they said “…we wouldn’t use these words with people who don’t work in services, so why are we using them with the people we’re paid to support and to help?”

‘The Interface Between Racial Trauma and Restrictive Practices in Secure Settings’ from Dr Aisha Mirza and Chen Shoko provided a brief history of restriction used against racialised peoples and the impact of racial trauma on people’s experiences within mental health services and secure settings. “What we know from literature is that if you’re from a minoritised background, if you’re Black, Asian or from other minoritised backgrounds…you are three times more likely to end up on high dose medication, you are three times more likely to end up in long term segregation.” They highlighted the importance of clinicians’ taking time to get to know people’s stories and taking a trauma-informed approach to providing care and support.

Day 2 of the conference, opened with a keynote from Paul Dix, Behaviour Specialist at When the Adults Change and author of ‘When the Parents Change, Everything Changes’. His speech considered restrictive practices within schools and how positive signalling can make a significant difference to children whose behaviours have prior been met with punishment. “Little positive noticing is the start of relational practice.”

Amy Telford, author of ‘Autistic Female in a Neurotypical World’ presented ‘Micro- Trauma: How it accrues and its lasting impact’. Starting from her definition of micro-trauma: “subtle hurts which build up over time and which have a distorting impact on the person”, she drew on her personal experiences to explain how seemingly small incidents can have a significant impact on people and emphasised the need to treat people with respect and dignity at every stage of care.

We were delighted to welcome Leanne Gelder, Reducing Restrictive Practice Lead, National Mental Health, Learning Disability and Autism Quality Transformation Programme, who talked about importance of improving the culture of care and building trusting relationships within health care. She said, “Some of the people I’ve spoken to…don’t always recognise that they’re using a type of restrictive practice” and stressed the important of raising awareness of different types of restrictive practice to reduce this. This was followed by a keynote from Rebecca Bauers, Interim Director for People with a Learning Disability and Autistic People at the Care Quality Commission, introducing the CQC’s new policy position on restrictive practices and the five key areas of expectations the CQC has for themselves, providers, partners and people.

The final presentation of the conference was ‘How Do We Reduce Restrictive Practices in Dementia Services?’ with Alison Thompson, Clinical Academic Mental Health Nurse and Saru Mutebuka, Lecturer, both at the University of Stirling. They spoke about restrictive practices within dementia services and the factors contributing to their prevalence. Their keynote stressed the importance of getting to know someone’s history and understanding how to communicate effectively to reduce the use of restrictive practices. They urged us to remember that “a patient isn’t a disease with a person attached, but a life into which a disease has intruded.” [Ian Kremer]

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The conference explored wider topics including:

  • Psychological Restraint and Human Rights from Tallyn Gray, Human Rights Officer at Sheffield Health & Social Care NHS Foundation Trust and Lorena Cain, Nurse Consultant and Lead for Restrictive Practice at Longley Centre.
  • Body Worn Cameras in Inpatient Mental Health Wards from Keiran Wilson, Research Assistant in Mental Health Nursing at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.
  • The role of Practice Leadership in applying the HOPE(s) Clinical Model of Care, from Max Jervis Read, Kay Agbalajobi, Umariah Farooqi and Kate Gilbert.
  • Love in Therapeutic Relationships from Alexis Quinn, Manager at the Restraint Reduction Network.
  • Human Too: Why human rights matter in restraint reduction with Sanchita Hosali, CEO of the British Institute of Human Rights.
  • A Regulatory Approach to the Reduction of Restrictive Practices in Australia with Donna White, Director of the National Policy and Clinical Guidelines Team at the Australian NDIS Quality and Safeguards Commission.

Delegates both in-person and online were engaged in lively debate and conversation throughout the two days. Comments from delegates and chairs included:

“Inspired by: Passion of the presenters today; Family feeling heard (Hope); SWS Declaration of Independence; Practising Abundantly Generous Curiosity; Receptive nature of the delegates to the messages presented.”

“All presentations were informative and interesting. They have offered a good insight to best practice and the messages from people with lived experience were especially powerful.”

“Made me reflect on current professional boundaries and how these can be a barrier to building relationships.”

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