DESIGN IN MENTAL HEALTH 2022 KEYNOTES


Prof. Brown said that when The International Issue booklet was being put together, the authors found ‘an international consensus that we should be using less restrictive interventions’.


Highlighting important themes The Professor said that while she and Prof. Brown would be presenting on a specific study, they would not be comprehensively reporting on the research project, but rather highlighting ‘some key themes’, ‘to open up a dialogue between ourselves and you’. Here Professor Brown took the podium. He said: “So, at the heart of restrictive interventions and seclusion is something of a paradox. When we were putting together the new The International Issue booklet with Donna Ciarlo for this year’s conference, we found an international consensus that we should be using less restrictive interventions, and making less use of seclusion; this was apparent from all around the world. We thus all know we should be doing less of it, buy why aren’t we?” Prof. Brown explained – and this was a project that the DiMHN would be actively engaged in over the next year – that he, Professor Reavey, and their fellow researchers, were ‘exhaustively trawling the evidence base on what the potential benefits of seclusion and restrictive practices are’; however, it was ‘proving difficult to find any’.


Extensive systematic review A systematic review early in the first decade of this century, which looked at ‘some 500 studies’, had uncovered just two exhibiting ‘anything that resembled positive benefits’. Prof. Brown said: “So this paradox, of restrictive intervention and seclusion, suggests something very complicated is going on at the heart of this. We know, for example, that there’s still a lot of restrictive intervention going on, and that it can have often have the opposite effect to what is intended – creating a sense of an unsafe, rather than a safe, environment, and leading to a loss of ‘personhood’, and to a sense of disempowerment. We also know that many staff hate being involved in restrictive interventions and seclusion, and feel it undermines their role.” The


THE NETWORK | NOVEMBER 2022


The study saw a significant number of staff and service-users interviewed to gauge their views, perceptions, and experiences.


Professor said it was also well understood that restrictive intervention and seclusion can create ‘feelings of anger, loneliness, and sadness’, among service-users. He said: “It can be corrosive of staff / patient relationships, and can feel antithetical to the work of care. However, many staff working in mental healthcare feel there are very good reasons for using restrictive interventions and seclusion. We also know that there is a broad range of things that might fall within the ‘family’ of de-escalation techniques and restrictive interventions, but we don’t necessarily understand the sequencing and ‘patterning’ between them.”


Some of the key issues examined The Professor said ‘what all this told us’ was that ‘we need to understand the paradox at the heart of all of this to be able to consider it in more effective and sophisticated ways’. The study that he and Prof. Reavey would discuss was, he explained, a pilot that began prior to


COVID, which sought ‘to try to address that paradox’. He elaborated: “So, we wanted to know things such as ‘How can patients calm down if they’re isolated in small rooms?’, ‘How can staff members feel safe and calm with this sort of risk of aggressive behaviour on the ward?’, ‘What specific aspects of the environment are related to aggression, and how do they become relevant in the process of escalation, where various restrictive interventions are then introduced?’, ‘Which techniques could be used, and with what sequencing’, and ‘How is it that people go through a pathway of those techniques that culminates in them being put in seclusion?’” Taking over the microphone, Professor


Reavey explained here that she and Prof. Brown would be discussing ‘a very specific part’ of the study today. She said: “This is because, while originally the study comprised quantitative research measuring the ‘atmosphere’ of the ward, and looking at patient and staff satisfaction levels when de-escalation


The conference audience was drawn from across the mental healthcare sector, and included estates and facilities, clinical and nursing, and architectural and design professionals, from both the public and private sectors, as well as service-users and academics.


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