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Restrictive practices are techniques such as physical restraint, seclusion and rapid tranquilisation used to limit a person’s liberties, movements or freedom to act independently in potentially dangerous situations.

The inappropriate or overuse of restrictive practice in mental health services has been identified as an area of concern in healthcare since at least 2015, and our ongoing work to reduce restrictive practices was highlighted as part of our celebration of World Patient Safety Day in September.

Following on from her visit to an acute female psychiatric ward in August, HIN Patient Safety Project Manager Ayobola Chike-Michael visited Tolworth Hospital’s Jasmines Ward in South West London to see how they are working to reduce restrictive practices and create a compassionate and supportive environment for all patients.

In the ever-evolving landscape of mental health care, the Mental Health Safety Improvement Programme has been making significant strides since its inception in 2021. With a strong focus on reducing restrictive practices, the programme aims to reduce occurrences of physical restraints, seclusion, and rapid tranquilisation across participating wards. During my visit to Tolworth Hospital's Jasmines Ward in South West London, I had the opportunity to meet Hannah McCarthy, the new ward manager, and gain valuable insights into their innovative approach to care. The commitment and dedication of the Jasmines Ward staff to create a safe and compassionate environment were evident from the moment I stepped in.

Jasmines ward, a 16-bed mental health ward for older adults presented a unique set of challenges and requirements. A large proportion of the patients on the ward are living with dementia. While incidents of restrictive practices were explained to me as rare due to the frailty and older nature of the patients, the ward manager and her team seem prepared to handle any situation that might arise. The staff focus on providing personalised care, ensuring everyone’s needs were met. One notable practice was the "This is me" profile on the door of each patient, fostering a sense of identity and promoting a person-centered approach acknowledging each individual’s cultural and family background, as well as their interests and achievements.

The success of Jasmines Ward in providing comprehensive care can be attributed to its robust Multidisciplinary Team (MDT). Comprising of doctors, occupational therapists, physiotherapists, a dietician, an activity coordinator, an exercise therapist, the pharmacist and, upon request, visits from a chiropodist. The MDT works seamlessly to address the diverse needs of the patients. This collaborative approach ensures that the care provided is holistic, focusing not only on mental health but on physical wellbeing too.

The team working on Jasmines Ward recognises the importance of maintaining the dignity and pride of their patients, even during moments of potential restraint. Incidences of restrictive practice are handled sensitively, ensuring safety whilst minimising distress.

Like any healthcare setting, Jasmines Ward faces its own set of challenges; ensuring staff have time and are trained to lead on person-centred care remains a priority. To address this issue the ward is actively seeking long-term solutions; a recent recruitment drive has been successful and the ward are expecting the arrival of five new nurses to join the team in the near future. Flexibility with shifts and a focus on work-life balance are expected to create a more sustainable and fulfilling work environment.

The Mental Health Safety Improvement Programme has introduced several tools to monitor and track restrictive practices effectively. One such tool, the safety cross, is a simple visual representation that enables staff to identify patterns at a glance

In addition to their existing use for falls, the ward is encouraged to also implement safety crosses specifically for restrictive practices. This tool has proven invaluable in other participating wards to shape discussions around frequency of restrictive practices, de-escalation techniques, and proactive interventions.

Stepping into Jasmines Ward, I was greeted by a fast-paced atmosphere catering for patients’ needs constantly. Each patient's door bore a simple profile, offering a personal touch that goes a long way in making patients feel comfortable. The ward faces challenges related to the space available, particularly around storage, but despite this the staff remain dedicated to finding solutions and putting patient well-being at the centre of everything they do.