Paul Farmer, Chief Executive, Mind Paul Farmer has been Chief Executive of Mind since 2006 and is currently the Chair of the Charities Consortium and leads the NHS England Mental Health Patient Safety Board. Previously, he has worked for Rethink Mental Illness and Samaritans. Mr Farmer was praised by his charity sector peers when he was voted most admired charity chief executive at the Third Sector Most Admired Charities Awards 2013. He also received an Honorary Doctorate from the University of East London in recognition of his promotion of the understanding and support of mental health. In June 2013, Mind released a review into the use of restraint in mental health settings and it has been instrumental in highlighting the issues to policy makers. Presentation Topic: Listening to experience, reduce restraint

1. Listening to experience, reducing restraint
Paul Farmer
Chief Executive
Mind
mind.org.uk

3. About Mind
• We provide advice and support to empower
anyone experiencing a mental health problem
• We campaign to improve services, raise awareness
and promote understanding
• We work in partnership with over 150 local Minds
to provide services tailored to their community
• People with mental health problems inform
everything we do

4. The road to national guidance
• Continued lack of ‘definitive guidance’ and nationally
accredited training following David ‘Rocky’ Bennett’s
death in 1998 and despite further deaths and
inquests
• Winterbourne View
• Mind’s independent inquiry and crisis care campaign
• RCN Congress debate and leadership
• People doing things differently – 6 Core Strategies,
No Force First, Safe Wards, Respect …..

5. Mind’s inquiry
“When we think of acute care, do we think of locked wards
or someone being held face down? Or is this practice
stopped and filed in the archives of history? What the
people called for in this report is humanity – for care to
be humane. I believe people can deliver this and more
…..”
Paul Grey, Mind Inquiry Chair, Listening to Experience report

6. Mind’s campaign
“need to change culture and
environment…. for support
and accredited training for
staff… underpinned by
respect for service users
and involving those who have
been at the wrong end of
restraint procedures”
Dr S P Sashidharan

7. Mind’s campaign – what we found
• Incidents of physical restraint
Number of respondents: 47 (87 per cent of all trusts)
Total: 39,883
Range: Highest 3,346; lowest 38
Median: 455
• Face down restraint
Number of respondents: 27 (50 per cent of all trusts)
Total: 3,439
Range: Highest 923; lowest 0
Latest national figures at
http://www.hscic.gov.uk/suppinfofiles

8. Mind’s campaign – what we found
• Traumatic experiences
• Failings in communication and in post-incident review
• Negative experiences of Black people and local
success in campaigning for change
• Concerns among staff

9. “Restraint is overused in my experience. Often staff
would not bother to try and understand patients -
and would just assume they were being irrational or
delusional. My partner was treated very roughly
when she refused to take medication. This was
because she had had bad side effects before and
the staff refused to explain what medication she was
being given. When I persuaded staff to actually
listen to her they eventually sorted it out”
[Carer’s quote in evidence to Mind’s inquiry]

10. I’ve suffered physical abuse when I was younger and
being held down where someone forces their weight
on you is triggering for me… it’s the last thing that’s
going to make me conform; I don’t want them touching
me.

11. Coming out of a psychotic episode is always scary, but
the staff were always sure to inform me of what was
going on so that I was not confused as to why
somebody was holding my arms. They would repeat
that I had been trying to hurt myself and they were
doing this to protect me until they were sure I had
understood.

12. Mind’s campaign – what we found
• Initiatives to work differently, for example:
oSheffield Health and Social Care Foundation Trust
using RESPECT Training Solutions’ training and
techniques
oIMROC sites using recovery principles in clinical
practice and developing No Force First
oHertfordshire Partnership NHS Foundation Trust’s
conflict reduction strategy

13. Positive and proactive

14. Positive and proactive
All services where restrictive interventions may be
used must have in place restrictive
intervention reduction programmes which
can reduce the incidence of violence and
aggression and ensure that less detrimental
alternatives to restrictive interventions are used.

15. Positive and proactive – service user
engagement
Wherever possible, people who use services, family
carers, advocates and other relevant representatives
should be engaged in all aspects of planning
their care including how to respond to crisis situations,
post-incident debriefings, rigorous reporting
arrangements for staff and collation of data regarding
the use of restrictive interventions.

16. Post-incident review
The aim should be to understand from the
person’s point of view how the service failed to
understand what they needed, what upset them the
most, whether staff did anything that was helpful,
what staff did wrong, and how things could be
better the next time. It is also important to
establish whether anything could be done differently
to make a restrictive intervention less traumatic.

17. Local policy frameworks
All policies must be co-produced with people who use
services and carers …
The policy should explain how people who use services, their
carers, families and advocates participate in planning,
monitoring and reviewing the use of restrictive
interventions and in determining the effectiveness of
restrictive intervention reduction programmes. This will
include providing accessible updates and publishing key
data within quality accounts (or equivalent report).

18. Positive and proactive workforce
“All learning should
be co-produced”

19. Listening to experience, reducing
restraint
• The voices of people at Winterbourne View were not
heard
• People with experience of being restrained spoke out
in Mind’s campaign
• People with experience of being restrained
successfully influenced their Trust in Sheffield
• Restraint reduction strategies include peer role and
debriefing – and engagement is relevant to all
aspects
• Don’t try to do this without people who have
experienced restraint

20. Any questions?
For more information:
Visit www.mind.org.uk
Contact – p.farmer@mind.org.uk