New guidelines on the recording, monitoring and regulation of restrictive interventions (RI) have just been published by the Royal College of Psychiatrists. Ben Higgins and Sarah Leitch from BILD provided input during the preparation of the report. The guidance focuses on inpatient services, but the principles can be applied to most settings and client groups, such as schools, care homes and residential.
One of the authors, Verity Chester, said: “The key message is to move beyond a numbers-based approach to monitoring RI. Numbers alone do not assess the quality of a services’ RI practice and cannot indicate good or poor standards, or abuse. For example, if a service reports one only physical restraint in six months, it is currently viewed more positively than a service that reports ten in the same timeframe. However, if the one restraint was unnecessary, unsafe or abusive, this is not uncovered by simply looking at the numbers.
“It is recommended that there must be more focus on factors such as: staff training in preventative strategies, the quality of individualised RI reduction plans, physical health observations and debriefing processes. It is important that wider practice quality issues are considered, such as are there enough staff on duty to provide positive activities and experiences, and to avoid conflict situations arising? Another key message is that written incident reports should be inspected, to assess whether these demonstrate principles of least restrictive practice. For example, was the decision for the RI justified, for the patient’s own, or others safety? It is hoped that the guidance will promote a positive shift in practice, to improve the lives of people affected by RI.”