For more information about the Network
call 0121 415 6960 or email RRN@bild.org.uk
Like-minded organisations in pursuit of restraint-free services

Guest blog: Swansea Bay Mental Health and Learning Disability Delivery Unit on why the Restraint Reduction Network Pledge is important to them

Written by Paula Hopes, Learning Disability Nurse Consultant for Swansea Bay Mental Health and Learning Disability Delivery Unit.


As a delivery unit we have been working on a multi-faceted approach to reducing restrictive practice, we keenly anticipate the messages from Welsh Government which will come with the reducing restrictive practice framework when it is launched later this year and it is an absolute pleasure to write this blog and share our ideas on why this pledge is important to us.

The people who use our services need to have confidence that their rights will be upheld. People deserve to be supported in safe and person-centred ways, we expect our services to be pro-active, values based and to implement the Positive Behavioural Support (PBS) framework. Taking this pledge is one more way of evidencing that.

‘Our practice is to employ the least restrictive interventions in order to achieve a safe outcome for the person and manage presenting risk, whilst maintaining dignity and quality of life’.

Many of our care plans state this as a goal to guide the way that we support people using our services who may be at risk of restrictive practices. By taking this pledge we want to make sure that we are all on the same pages, by publicly declaring our commitment to improving quality of life and reducing restrictive practice. We want to be clear that we know that often the use of restriction is unpleasant, distressing, damaging and potentially dangerous for the people that use our services and our colleagues. We are clear that as an organisation we do not want to restrict people unnecessarily and induce fear, distress, trauma or the potential for abuse.

‘Our practice is to employ the least restrictive interventions in order to achieve a safe outcome for the person and manage presenting risk, whilst maintaining dignity and quality of life’.

Using restrictive practice as an intervention should present moral and ethical challenges for individuals and the organisations that they work in.

There can be serious implications for people and the therapeutic relationship that they have with staff and systems in which they are being cared for. By taking the pledge we are ensuring that the human rights of the people who use our services are valued and recognised and we are giving clear and transparent indication of the way that we want our services to treat people who may be exposed to potential abuses through restriction particularly where this might be inappropriate or uninformed. We will ensure that there is internal and external scrutiny when depriving a person of their liberty.

By taking the pledge we are ensuring that the human rights of the people who use our services are valued and recognised and we are giving clear and transparent indication of the way that we want our services to treat people

Being honest and transparent

We acknowledge that there are occasions where restrictions will be used within services to keep people safe and to support de-escalation of behaviours which could cause harm to the person or people around them. We want to ensure that restraint and restriction are only as a last resort to keep people safe. However, we cannot get away from the challenge of how we do this and the ethical dilemmas we face. It is essential that we remember ‘restrictive practice is making someone do something that they don’t want to do or stopping someone from doing something that they do want to do’, (Skills for Health, 2014).

We believe in a rights based approach to the care and treatment of people who use our services- our health board values are written in a simple, easily relatable, values based way: caring for each other, working together and always improving. By taking the reducing restrictive practice pledge we are reinforcing across our health board how we are living these values. The process of developing our pledge was evidence based, reflective of our work streams on safeguarding, positive behaviour support, our strategic framework for reducing restrictive practice and positive behaviour management (Bild Association of Certified Training certificate).

We believe in a rights based approach to the care and treatment of people who use our services

Sitting down as a team to develop the pledge allowed us to clarify the strategies we have in place for further governance around this agenda and recognise who are our key partners in helping us take this forward. The pledge was written after colleagues had been to the House of Lords for the launch of the RRISC report, the stories and commitment of families in the room to make change happen inspired our clinicians in SBUHB to demonstrate their commitment.

We will evaluate the extent to which we implement this pledge in practice, celebrate our success and address any areas where we do not live up to our standards in practice.

The pledge shows our commitment to reducing restrictive practice and evidences the strategies we have for driving the agenda forward. By pledging in a public way we are holding our services up, evidencing our responsibility and accountability in a clear and transparent manner that invites scrutiny and reflects the level of commitment from our organisation.

By pledging in a public way we are holding our services up, evidencing our responsibility and accountability in a clear and transparent manner that invites scrutiny and reflects the level of commitment from our organisation.

We believe that other organisations should take the pledge in order to evidence that they understand the implications of restrictive practice and are committed to improving the quality of life of people who use their services. The development of the pledge will support in identifying partners for taking forward, potential areas for further development but might also allow the organisation to recognise how far they are with their overall reducing restrictive practice agenda.

Find out more about becoming an organisation member of the Restraint Reduction Network here>