The Reducing Restrictive Practice Collaborative was established to encourage peer-to-peer learning between wards across England, with the aim of reducing restrictive practices.
What are restrictive practices?
The Mental Health Act defines restrictive practices as ‘deliberate acts on the part of other person(s) that restrict a patient’s movement, liberty and/or freedom to act independently in order to:
- Take immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is undertaken, and
- End or reduce significantly the danger to the patient or others.
Restrictive interventions should not be used to punish or for the sole intention of inflicting pain, suffering or humiliation.’
How did the Reducing Restrictive Practice Collaborative work?
This Collaborative was designed with individuals who have expertise in reducing restrictive practice, such as clinicians and academics, and people with lived experience as a patient or carer. It was adapted from the Institute for Healthcare Improvement’s (IHI) Breakthrough Series Collaborative model.
It formed part of a wider Mental Health Safety Improvement Programme (MHSIP) that we established with NHS Improvement as a response to the report by the Care Quality Commission, following a request made by the Secretary of State.
Wards were provided with tools and resources to develop their own quality improvement (QI) plans and were supported to implement them through bimonthly learning days and working with dedicated QI coaches.
Watch the video for a brief explanation of the RRP Collaborative by Dr Amar Shah, the National QI Lead for the Reducing Restrictive Practice Collaborative:
Journal paper about the RRP Collaborative (May 2022)
Shah A, Ayers A, Cannon E, Akhtar S, Lorrimer K, Milarski M, Arundell L-L. The mental health safety improvement programme: a national quality improvement collaborative to reduce restrictive practice in England. British Journal of Healthcare Management. 2022;28(5): https://doi.org/10.12968/bjhc.2021.0159
In 2018, 38 mental health inpatient wards belonging to NHS trusts across England took part in the national reducing restrictive practice collaborative project, which aimed to reduce the use of rapid tranquillisation, restraint and seclusion of patients by 33%. Teams were supported to use quality improvement tools by skilled coaches as part of a national collaborative learning system.
At the end of the programme, the overall use of restrictive practice had reduced by 15%. Of the teams that achieved improvements, the average reduction in restrictive practice was 61%. Across the collaborative there were improvements in the mean monthly use of restraints and rapid tranquillisation, and in the total use of all three measures of restrictive practice combined. Support from quality improvement coaches allowed ideas to be tested across the collaborative, enabling the creation of a theory of change for reducing restrictive practice based on areas with a high degree of belief to inform future improvement work in this area.
Why target restrictive practice?
In their report, The State of Care in Mental Health Services 2014 to 2017, the Care Quality Commission found that some patients are still receiving ‘overly restrictive’ care, despite the concept of least restriction being a guiding principle in the Mental Health Act legislation since 1983.
Case studies: experience of restraint
Mary and Chris are experts by experience. They speak openly about their experiences of mental health problems, their feelings about the use of restrictive practices and their hope about the impact that the Reducing Restrictive Practice Collaborative will have.
Case study: Seni’s law
Seni Lewis’ is a well-known case where restrictive practice was used unethically. In 2010, 23-year-old Seni died after being restrained by 11 police officers on a mental health ward. The Mental Health Units (Use of Force Bill) known as Seni’s law was passed in 2018.
Who took part?
In total, 38 wards across England participated in the Reducing Restrictive Practice Collaborative. They included psychiatric intensive care units (PICUs), children and adolescent mental health services, and acute, dementia and forensic wards, both mixed and single sex.
- Amber Ward, Sussex Partnership NHS Foundation Trust – PICU
- Bethlem PICU, South London and Maudsley NHS Foundation Trust – Adult PICU
- Bradley Brook Ward, Avon and Wiltshire Mental Health Partnership NHS Trust – Medium Secure Unit
- Christopher Unit, Essex Partnership University NHS Trust – Adult PICU
- Colne Ward, Central and North West London NHS FT – Adult PICU
- Coral PICU, Camden and Islington NHS Foundation Trust – Adult PICU
- Crystal Ward, East London NHS Foundation Trust – Adult Male PICU
- Endcliffe PICU, Sheffield Health and Social Care NHS Foundation Trust – Adult PICU
- Fraser House, Cumbria, Northumberland, Tyne and Wear NHS FT – Adolescent Learning Disability
- Galaxy Ward (Coborn Centre), East London NHS Foundation Trust – CAMHS PICU
- Garner Ward, Cornwall Partnership NHS Foundation Trust – Adult Dementia Ward
- Great Yarmouth Acute Service, Norfolk and Suffolk NHS Foundation Trust – Adult Acute Admissions
- Harvest Ward, Cornwall Partnership NHS Foundation Trust – Adult PICU
- Hawthorns 1, Southern Health NHS Foundation Trust – Adult PICU
- Irwell Ward, Greater Manchester Mental Health NHS Foundation Trust – Adult PICU
- Juniper Ward, Barnet, Enfield and Haringey NHS Foundation Trust – Adult Female Forensic (medium secure)
- Jupiter Ward, South West London and St Georges Mental Health Trust – Adult Acute Admissions
- Kestrel Ward, Oxford Health NHS FT – Adult Low Secure
- Knights Ward, North East London NHS Foundation Trust – Acute Adult Female
- Lark Ward, Norfolk and Suffolk NHS Foundation Trust – Adult PICU
- Lilac Ward, South West London and St Georges Mental Health Trust – Adult Acute Admissions
- MacArthur Unit, Black Country Partnership NHS Foundation Trust – Adult Male PICU
- Malcolm Faulk Ward, Southern Health NHS Foundation Trust – Medium Secure Unit
- Maple Ward, Sheffield Health and Social Care NHS Foundation Trust – Adult Acute Admissions
- Maple Ward, Solent NHS Trust – Adult PICU
- Maplewood Male LSU Ward, Mersey Care NHS Foundation Trust – Male Low Secure
- Marina PICU, Northamptonshire Healthcare NHS Foundation Trust – Adult PICU
- Nostell Ward, South West Yorkshire Partnership NHS Foundation Trust – PICU
- Pavilion Ward PICU, Sussex Partnership NHS Foundation Trust – Adult Male PICU
- Poplar Ward, Essex Partnership University NHS Trust – Adolescent Assessment Unit
- Rowans Ward, Coventry and Warwickshire Partnership Trust – Adult Female PICU
- Seagrove Ward, Isle of Wight NHS Trust – PICU
- Stewart Ward, Southern Health NHS Foundation Trust – Adolescent Medium Secure Unit
- Titian PICU, North East London NHS Foundation Trust – Adult Male PICU
- Waterloo Ward, West London Mental Health NHS Trust – Adult Male PICU
- Waveney Ward, Norfolk and Suffolk NHS Foundation Trust – Adult Acute Admissions
- West Ferry Ward, East London NHS Foundation Trust – Adult PICU
- Willows PICU, Nottinghamshire Healthcare NHS Foundation Trust – Adult Male PICU
Meet the team
- Amar Shah – National QI Lead
- Tom Ayers – Senior Associate Director, NCCMH
- Dominique Gardner – Project Manager, NCCMH
- Kate Lorrimer – QI Coach, NCCMH
- Emily Cannon – QI Coach, NCCMH
- Saiqa Akhtar – QI Coach, NCCMH
- Matthew Milarski – QI Coach, NCCMH