Written by Martin Delgado, Peer Debrief Volunteer:

“C&I has taken a bold and innovative approach to improving standards of care for service users by recruiting volunteers to interview patients who have been physically restrained.

The Trust is one of the first in the country to launch the Peer Debrief initiative after the National Institute for Health and Care Excellence (NICE) published new guidelines recommending that individuals who are external from the Trust be brought in to talk to patients after restraint incidents on a ward.  Some volunteers and Trust staff involved in the initiative are pictured above.

The scheme, which is being rolled out across wards at St Pancras and Highgate Mental Health Centre, has so far proved successful and was singled out for praise in the latest Care Quality Commission report, published in March 2018. There has been significant interest in the model from other mental health trusts, who have asked C&I about setting up their own Peer Debrief schemes.

Several of the C&I volunteers are former patients with ‘lived experience’ of mental health issues, though there are plans to expand the team by recruiting more widely among carers and in the voluntary sector.

Kevin Cann, C&I’s Prevention and Management of Violence and Aggression Lead, said: “The Trust’s strategy to reduce restrictive practice is not just about reducing the number of prone restraints. It’s about improving the standard of all restrictive practices so they become safer and less disturbing for service users.”

“Due to the Peer Debrief staff being external to the Trust, patients are more open with them about why the incident happened and how it can be prevented in the future.  This is information we would otherwise not have been able to obtain.”

The interview questions aim to aid consistency; are intended to establish what may have led a patient to behave violently or aggressively; whether the subsequent restraint was carried out in a way which minimised physical and psychological harm to the service user; and how restraint can be prevented in the future.

Interviewees are also offered advice on how to access advocacy if they feel they were subdued in a manner which failed to meet the high standards expected of C&I staff.

Senior managers, however, emphasise that there is no intention to ‘blame’ staff involved in restraint incidents. Individuals are never named in the reports filed by volunteers. The aim is to encourage reporting of restraints and, over time, to reduce their number, leading, it is hoped, to less aggression on wards and beneficial results for all clinical staff and patients across the entire C&I estate.

The data is showing a clear emphasis on the importance of communicating effectively with patients to prevent frustration and anger building up. Recurring themes are beginning to form, with a clear emphasis on improved communication between staff and patients on what is happening and why.

Kevin Cann commented: “The key to reducing violence is early intervention and planning. The nursing teams are always pushed for time but taking preventative measures such as behavioural support planning with the patient to avoid restraint saves a lot of time further down the line.

“After each interview, the volunteers give one copy of their report to the patient and another to the ward manager. Findings are also inputted into a database so that issues which occur repeatedly in debriefs can be spotted and action taken to address concerns.

“Patients have often commented that when staff debrief them after a restraint, there can sometimes be a feeling of ‘punishment’ that shuts down dialogue. That’s why Peer Debrief is so important. It gets across the message that we are curious about how and why it happened and we want to stop it happening again.”