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6 September 2021

Blog by Alice Fletcher

Alice Fletcher

A woman lost her son after he was restrained in a seclusion room in a London hospital. She told her story at an event I attended recently and it underlined the importance of the work I am now undertaking.

I started my new role recently and I am the first programme manager at the Innovation Agency to work solely on mental health programmes, which is a fantastic opportunity for myself and the organisation.

I have a real passion for mental health and I want to be able to make a tangible difference to the mental health care provided to patients across the North West Coast. 

Focus on reducing restrictive practices

My main focus is the Mental Health Safety Improvement Programme, a national workstream delivered by all 15 Academic Health Science Networks (AHSNs). The first phase of this is about reducing restrictive practice on mental health inpatient wards, hence my attendance at the event.

Restrictive practice is measured by the use of restraint, seclusion and rapid tranquilisation. It can however include any act that restricts the patient’s liberty and other rights, for example stopping patients from accessing an outdoor space.

During the COVID-19 pandemic we have seen more patients attending A&E, and more patients going to their GP or accessing mental health services. This means we have seen a higher number of mental health admissions.

Since the pandemic started there have been challenges in mental health staffing due to staff members having to isolate. This has put pressure on the mental health system and highlights just why this is such an important piece of work and that it has the potential to make a big difference to patients and staff.

I attended the national programme launch event in May, when it really hit home for me just how necessary and important this work is. The speaker who moved us all was Mrs Ajibola Lewis who lost her son Olaseni Lewis in 2010 after he was restrained in a seclusion room following a voluntary mental health admission.

This was just one example of an event of restrictive practice that could have been dealt with differently if all staff had adequate training and knowledge of other methods. There are several occurrences of restrictive practice that occur daily and the programme will help clinicians explore other options where appropriate.

Slippers – a simple solution

I would like to share an example that I came across in which an alternative to restraint was successful and improved the care of the patient. A man was admitted to a mental health ward and he was wearing steel toe cap boots which could have caused harm to other patients and staff.

The man was asked to remove his boots, but he refused and became very agitated and distressed. At this point staff felt that in order to keep other patients safe they would need to restrain the man and remove his shoes for him.

One staff member rushed to Primark in their lunch break and bought a pair of warm slippers. When these were offered to the man he quickly removed his boots and was delighted with his new footwear.

This highlights how new approaches do not have to be complicated, they just need to keep the patient at the heart of the decision-making to get the best outcome

Building on achievements

I am absolutely over the moon that all the North West Coast mental health trusts have agreed to be part of this national programme. While they have already been focusing on this work, the national programme will be a great opportunity to build upon their achievements.

Initially I am going to be working with a small number of wards in each of the mental health trusts and working through some change ideas using a quality improvement approach.

I am going to be working very closely with clinicians in a working group to understand the complexities of the different wards and will be exploring the ward culture as well as looking at the national measures.

There will soon be a Mental Health Project Manager starting at the Innovation Agency which I am really excited about, to join me in this work.  

I am very much looking forward to helping to make a difference in the mental health system; if you are interested in this area, please get in touch.

Also – please join us for our first North West Coast collaborative event to discuss reducing restrictive practice and to establish a supportive network for staff in mental health trusts. You can book a place here.

Alice Fletcher, Programme Manager for Patient Safety (Mental Health)

@Alice_Fletcher_

Alice.Fletcher@InnovationAgencyNWC.NHS.UK

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