Useful documents that complement this guidance

• NHS Protect (2013): Meeting needs and reducing

distress: guidance on the prevention and management of clinically related challenging behaviour in NHS settings7 This guidance was developed by an expert group comprising doctors, security specialists and nurses. It provides important practical strategies, which should be applied across clinical settings, in order to help identify, assess, understand, prevent and manage clinically related ‘challenging behaviour’, by preventing or minimising a person’s distress, meeting their needs, and ensuring that high quality care is delivered within a safe environment. The principles and approaches outlined apply to any adult patient in an NHS healthcare setting. Although specific techniques and interventions may differ, strategies for delivering high quality personalised care that meets a person’s needs remain the same. The importance of positive engagement, communication between staff and de-escalation approaches are strongly emphasised.

• HM Government (2014): The Mental Health Crisis Care

Concordat: improving outcomes for people experiencing mental health crisis8

This Concordat is a multi-agency agreement between signed by more than 20 organisations including the police, mental health trusts and paramedics that describes what people experiencing a mental health crisis should be able to expect of the public services that respond to their needs.

It is about how these different services can best work together, and it establishes key principles of good practice that local services and partnerships should use to raise standards and strengthen working arrangements. In particular it examines how local authorities, health providers (including A&E departments) and the police service should work effectively.

• NHS England & Local Government Association (2014):

A Core Principles Commissioning Tool for the development of Local Specifications for services supporting Children, Young People, Adults and Older People with Learning Disabilities and/or Autism who Display or are at Risk of Displaying Behaviour that Challenges9

With the aim of informing decisions concerning the commissioning of services, the document was produced as a direct response to the scandalous events revealed to have occurred at Winterbourne View. It describes the core principles that should be present across all services for people with learning disabilities and / or autism who either display or are at risk of displaying behaviour which challenges.

The document highlights the importance of a relentless person centred focus on outcomes, with all decisions being based on the best interests of the individual and a full recognition that family carers are most often those who know what the ‘best interests’ are. Rigorous adherence to the core principles will improve individuals’ quality of life and reduce the prevalence and incidence of behaviour that challenges as well as inappropriate placements and the use of restrictive interventions

• NICE (2005): Clinical Guideline 25. Violence: the short-

term management of disturbed / violent behaviour in in-patient psychiatric and emergency departments10 This guidance examined and reported on the evidence base for the emergency management of acute behavioural disturbance across a selection of healthcare settings. Interventions and topics that are examined include: the care environment, prediction of violence and aggression, training, service user perspectives, emergency

departments and the use of intensive supportive observations and a range of restrictive interventions. It is currently being updated in light of new and emerging clinical evidence and the new guidance is expected to be published in April 2015. When published, the expanded guidance will have broader applicability across the full range of adult health and social care services.

• Department of Health (2008): Mental Health Act 1983

Code of Practice11

The Code provides guidance to staff who are involved in the treatment, care and support of people under the Mental Health Act 1983. Chapter 15 of the Code is of particular interest; it provides guidance on a range of interventions which may be considered for the safe and therapeutic management of hospital in-patients (whether or not they are detained under the Mental Health Act 1983) whose behaviour presents a particular risk to themselves or to others.

The Code is currently being revised and is likely to be published late 2014. This will compliment this guidance, including having a stronger focus on positive and proactive care as well as additional safeguards around the application of restrictive interventions.

• Skills for Care/Skills for Health (2014) A Positive and

Proactive Workforce: a guide to workforce development for commissioners and employers seeking to minimise the use of restrictive practices in social care and health12 This important guide is for commissioners and employers who are responsible for the development of a skilled, knowledgeable and competent health and social care. The document provides advice on the development of staff with the aim of ensuring that the use of restrictive interventions is minimised.

The document addresses issues or developing person- centred organisational cultures, staff recruitment and retention, support, supervision, development of skills and knowledge and how to commission high quality training.

• Department of Health (forthcoming 2014) Positive

and Proactive care: reducing the new for restrictive interventions in the support and care of children, young people and individuals transitioning to adulthood Children and young people face particular difficulties in relation to positive and proactive care and support. This requires careful consideration of their physical and emotional characteristics as maturing, still developing people with varying needs and capacity to understand their circumstances and who exhibit a very diverse range of behaviours. The care and support of children and young people is provided within different legal and service context and in accordance with the UN Convention on the Rights of the Child.

Additional and separate guidance on reducing reliance on restrctive interventions when delivering services to children, young people and individuals in transistion is being developed.

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