• Improvement teams to visit 25 mental health trusts as part of a bid to prevent inappropriate physical restraint
  • Regulators want to address “wide variation” in use of physical restraint and restrictive practices

National improvement teams are set to visit 25 mental health trusts as part of a bid to prevent inappropriate physical restraint and other “restrictive practices”.

NHS Improvement and the Care Quality Commission have launched a pilot project to address the “wide variation” in how frequently staff use physical restraint to control patients’ behaviour. 

The regulators have asked the National Collaborating Centre for Mental Health, a research arm of the Royal College of Psychiatrists, to investigate the use of restrictive practices, such as physical restraint, rapid tranquillisation drugs and isolation rooms. The project aims to reduce these incidents by a third.

The project will cover 42 wards across 25 trusts. Trusts put themselves forward for the project, but the NCCMH was unable to share the details of the trusts. 

According to data the NCCMH collected, these trusts have collectively had more than 1,000 incidents involving restrictive practice on average per month. 

Paul Elliott, deputy chief inspector of hospitals and mental health lead for the CQC, said: “We are very concerned about the wide variation between services in how frequently staff use physical restraint to control patients’ behaviour.

“Those wards that rarely use restraint have staff trained in the specialised skills required to anticipate and de-escalate behaviours or situations that might lead to aggression or self-harm. Unfortunately, this good practice is far from universal.”

The CQC has highlighted concerns over the use of restrictive practices in several of its inspections this year, including those for North West Boroughs Healthcare Foundation Trust, Essex Partnership University FT, Barnet, Enfield and Haringey Mental Health Trust, and Northamptonshire Healthcare FT.

The project comes following the approval of a new law by MPs in July, called the Mental Health Units (Use of Force) Bill, which aims to improve transparency and accountability around the use of restraint in mental health units.

This includes the requirement to publish data on how and when physical force is used and ensuring that an independent inquiry is carried out following any non-natural death in a mental health unit.

Amar Shah, quality improvement lead for the project, said: “Restrictive practice is a complex safety issue that requires change in culture and behaviour, as well as new ways of working together.

“This programme presents a huge opportunity to learn together and empower our wards and service users to partner and test new ideas in the search for safer, more caring and recovery focused ward environments.”

This is the first in a series of mental health safety improvement programmes which NHSI and the CQC have initiated. Future programmes will cover sexual safety on wards and suicide prevention.