Using words not force

28 November 2016

The first national programme aimed at reducing and preventing restraint of mental health clients by boosting nurses' therapeutic communication skills was launched recently.

Moving to restraint-free mental health practice has been a focus in the sector for some time – in particular eliminating both painful holds and the use of prone-positioning (having the client lying face down which puts them at risk of asphyxiation). But a stocktake in 2014 by mental health workforce agency Te Pou found there was no consistent training across the country towards promoting restraint-free practice, said Lois Boyd, a nurse consultant working for Te Pou.

A best practice review and the stocktake resulted in a collaborative district health board project, lead-by the National Directors of Mental Health Nursing (DOMHN), called the Safe Practice Effective Communication (SPEC) training programme.  The programme aimed at mental health nurses and other mental health clinicians was formally launched at a national forum in late November.

Boyd said the SPEC programme was developed by DOMHN and Te Pou and was built on a training approach used successfully across the Northland and Auckland district health boards for seven to eight years.  The focus was on using evidence-based therapeutic interventions to foster effective communication and reduce the use of restraint and seclusion.  (Personal restraint is defined as a when a clinician or staff member "uses their own body to intentionally limit the movement of a consumer" for example holding them physically.)

SPEC uses a "train the trainer" model with about two-thirds of the DHBs now having trainers and it is to be rolled out to the remaining DHBs early in 2017. 

Boyd said the trainers' programme involves an initial four days training followed a month later by a further three day block, so seven days training in total.

She said rolling the training out to all mental health clinicians across the DHBs would require some time as SPEC required each clinician to undergoing a three consecutive days training programme.  After staff are trained DHBs typically offer a one-day refresher course each year. 

The focus is on therapeutic interventions but clinicians are also taught pain-free restraint techniques for scenarios when it is required for the safety of a mental health client as well as the safety of other service users and staff.

Boyd said the Te Pou stocktake found that some DHBs already following best practice therapeutic techniques had reduced the use of personal restraint to the point that restraint skills were rarely needed.  She said an analogy was that firefighters at airports need to be highly trained but it was hoped they never had to use their firefighting skills.

Last year Te Pou published Towards Restraint-Free Mental Health Practice which said successful models at reducing and preventing restraint use a range of approaches with key elements for successful strategies including both organisation and service-user (client/consumer) leadership, active involvement of frontline staff, cultural perspectives being included, an emphasis on teamwork and appropriate staffing levels and skill mix.

Currently the use of seclusion is reported to the Director of Mental Health but not the use of personal restraint.  A governance group has been set up to support the ongoing development and implementation of the SPEC programme including the nursing directors, Te Pou, service users groups and Māori.

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