Mental Health Units (Use of Force) Act 2018

Things to tell the people caring for you

Your ward is a safe and calming space to support your recovery. The team on your ward are trained and skilled in helping you with your mental health and physical wellbeing, always supporting your human rights and legal protections. If you want further information about this, please speak to a member of the team.

The best tip we can give is to talk to any member of your clinical team about your thoughts, feelings and wishes. Team members can talk you through all Use of Force options that might be used as a last resort, so you understand them.

Things to tell a member of your clinical team

• What helps you remain calm and well

• How you react to stressful things

• How you want staff to help you during those times

• As a last resort tell them how you would prefer to be cared for if the use of force is needed.

The team should ask the same questions to your carer, family, or anyone you think they should talk to. You can expect your doctor or nurse to raise this issue with you if they think it’s needed. If you feel you want to discuss this, you can do so with any member of the team.

The staff team will only use force as a very last resort. We want to be open and honest with you and hope that we can work together to never have to use it.

A calm and safe ward is something we should all expect. Aggression towards anyone is illegal and will be treated as such, should the clinical team think it’s needed they may involve the police. We can all contribute to a positive and safe ward.

Who to speak to if you thought force was used unfairly

The interventions that are used are only ever used as a last resort. They are only ever used to protect you or those in contact with you from harm. An example might be that you are harming yourself or someone else and the risk means we need to step in to prevent further harm.

When force is used it must be fair to you and support your human right to be safe while you are on our ward.

If you feel force was used unfairly, you can speak to:

• A member of the clinical team

• An advocate - staff can provide you with contact information

• Someone from the Patient Advice and Liaison Service (PALS)

• Make a complaint

Restrictive Practices

This is an umbrella term for making someone do something they don’t want to do or stopping someone doing something they want to do. In service settings it can be linked to the use of blanket rules which apply to everyone regardless, but may have a tenuous basis for application or are only necessary because of a specific individual risk.

This can include blanket rules, that affect everyone and can include locked doors or access to specific items. They can also be specific to you and will always be based on risk, this might include personal items like your phone. This is done to keep you safe and well and will be regularly checked to make sure limiting access is in your best interests. Speak to staff, an advocate, carer or family member if you think these decisions are wrong.

What are the different types of physical restraint?

What is use of force?

This is any time a staff member puts their hands on you to take control of your movement. Staff will always work with you to avoid this happening, but sometimes it might be necessary to keep you or those around you safe from harm.

The use of force includes:

• Physical, mechanical or chemical restraint of a patient
• The isolation of a patient, including seclusion and segregation

There are different kinds of physical restraint:

Seated - when a minimum of two people will support you to sit in a safe place, one person either side of you, also sitting. This may be carried out on a bag called a safety pod.

Standing - a minimum of two people either side of you will hold your arms and talk you through the moment you are finding difficult.

Prone - usually three people will safely hold you in a position on the floor, you will be laying on your front and someone with talk to you at all times.

Supine - usually three people will hold you on the ground, you will be facing up, again, someone will try to support you at all times.

Other types of restraint:

Seclusion - a safe space for people who are facing extreme emotional distress that is in a risk to that person or those around them. It is a low-stimulus room that can be adapted to support the person with emotional regulation It will always be used for the shortest amount of time and will only ever be used when other attempts to support the person have been exhausted.

Chemical - this medication that can be offered to support you when you are struggling with difficult emotions. If you are able to, we will offer you medicine in tablet form. If you are very distressed, we might feel an injection of the same medication is the best option (These medicines are not given often to people and we will always try and work with you to reduce distress without medicines when possible).

What happens after physical restraint takes place?

If for any reason you must be held by staff, or you have seen another patient being held, you will have the opportunity to talk to staff about how you felt through that experience. Talking helps to process how you felt and will also help us to support you and avoid there being next time

What is written down by staff?

All Staff must document every time you are held by them.

The record must include the following information:

• A description with the reason of why you were held.
• The place, date, and duration that you were held.
• The type or types of hold used on the patient.
• Whether the type or types of hold used on the patient formed part of the patient’s care plan.
• Your name.
• The way you identify.
• The name and job title of any member of staff who held you.
• Your diagnosis (if known)
• Your relevant characteristics (if known)
• Whether you have a learning disability or autistic spectrum disorders.
• A description of the outcome of you being held.
• Whether the patient died or suffered any serious injury because of being held.
• Any efforts made to avoid the need of you being held.

How do we keep you safe?

Mental health units have a responsible person

Whilst you’re in our care there is a responsible person that is designated to oversee the Mental Health Units (Use of Force) Act 2018.

This responsible person is employed by the Lincolnshire Partnership NHS Foundation Trust (LPFT) and of an appropriate level of seniority. This role is held by the Trust's Director of Nursing.

All staff involved in your care will have appropriate training

All the staff that are involved in your care whilst you stay with us have training that relates to the use of force.

The training provided includes training on the following topics:

• How to involve you in the planning, development and delivery of care and treatment on the ward,
• Showing respect for patients’ past and present wishes and feelings,
• Showing respect for diversity generally,
• Avoiding unlawful discrimination, harassment and victimisation,
• The use of techniques for avoiding or reducing the use of force,
• The risks associated with the use of force,
• The impact of trauma (whether historic or otherwise) on a patient’s mental and physical health,
• The impact of any use of force on your mental and physical health and the impact of any use of force on your development,
• How to ensure the safety of patients and the public, and the principal legal or ethical issues associated with the use of force.
• Our staff also attend Refresher training annually.

Police body worn cameras

If the police attend the ward for any reason, the police officers attending must wear a body worn camera and keep it operating at all times when reasonably practicable.

CQC involvement

Investigations will take place if a patient is hurt. The Care Quality Commission make sure healthcare staff follow rules to keep patients safe and will be told if a patient is hurt.

How to make a complaint

What if you need to make a complaint?

If you wish to make a complaint, staff will support you to do so. You can talk to any of the Staff on the ward, if you feel you want management to be involved, feel free to ask them for help.

You can also contact Patient Advice and Liaison Service (PALS)

They provide confidential advice and support, helping you to sort out any concerns that you may have about any aspect of your or your loved ones care.

Contact by phone: 01529 222265 or email: lpft.PALS@nhs.net

What if you have a comment, suggestion, compliment, or complaint about the service?

If you want to make a comment, suggestion, compliment, or  complaint you can:

• Talk to the people directly involved in your care
• Get in touch on the Trust website

Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.