DESIGN IN MENTAL HEALTH CONFERENCE 2019
celebrating the good work of particular wards or clinical specialisms was not only important per se, but also helped motivate other teams to progress. He added: “Data is a great thing in encouraging unofficial competition between different clinical environments, which I don’t think is necessarily a bad thing.”
Dave Riley went on to explain that staff who provide care within inpatient services have a comprehensive personal safety training programme that entails teaching them ‘preventative strategies with a last resort emphasis on physical intervention and restraint’. ‘Driven by the national model’, he explained that the Trust’s clinical staff had moved away from a model where ‘how to hold onto people dominated the curriculum’, with only ‘a cursory focus’ on de-escalation, to a completely re-configured training system, where the majority of time was focused on staff self-awareness. He said: “De- escalation is still there, but from a different perspective. We are now looking at what we can do better to calm people in distress, and, of course, also now have perspectives from people using our services, who are speaking up, and telling us what works for them at a human level. Our service-users want a relaxed approach, and staff who can bend rules where practical and employ interpersonal flexibility, not the rigidity that has often been a feature around previous de-escalation training. That re-balancing of
of celebrating success at the highest level. I consider it a personal responsibility to let executive teams know when our wards are doing some extraordinary things for the people they serve to increase flexibility and reduce conflict in our inpatient services.
Compassionate support at challenging times.
personal safety training has been key for us. I think many of the physical interventions taught in the gym in the past – often highly complex to learn – just ‘ticked a box’ for the organisation in many cases.”
Adversarial toward staff? The Mersey Care speaker said there had been a potential danger that the emphasis on less restraint and seclusion might be perceived as ‘adversarial’ toward staff by individuals who had provided inpatient care at Trust facilities for many years. He said: “We have emphasised to staff that this is absolutely not the case. Rather, our message is that the staff who deliver our services are fundamentally really good people trying to do their best in often challenging circumstances. What we find really important is a continuous practice
A ‘paradigm shift’ in approach “Recently, on one of our intensive care units,” Dave Riley recalled as his presentation neared a close, “a male service-user became distressed and wanted to leave. His main language was Italian, making it difficult for staff to intervene in the effective way I know they can. As he gradually got more distressed, the traditional approach would have been to herd every other inpatient down the corridor to a quiet, safe location, leaving the mental health professionals to de- escalate the situation and calm the man down. However, we had another service- user quite fluent in Italian, so the nurse-in- charge asked that individual to take over the de-escalation process. They in fact did that, and in a way that resolved things successfully. What I am seeking to get across is that our change of approach is a paradigm shift for many areas. The idea of mutuality – that we are in this together – is really important. I hope that I have given you a good sense at a human level of what we are trying to do to ‘re-design’ human experiences on our inpatient units.”
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THE NETWORK | OCTOBER 2019
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