‘To eliminate reliance on force we need to be so proactive that no one gets so unwell’
I have experienced mental health challenges since my teenage years and at different times in my life I’ve been reliant on secondary care services. However, it was spending six months on an acute ward at the Cambridge and Peterborough NHS Foundation Trust (CPFT) in 2005 that gave me the impetus to try and have some influence on the design and delivery of services. As an inpatient, I felt there were many opportunities to do things differently and to change the nature of day-to-day interactions. This was based partly on my own observations, but also on the experiences of other patients who were not always treated with compassion and understanding at times of heightened distress, for example when they had absconded. The crisis care that my peers received was patchy and although there were pockets of good practice there was a lack of joined-up thinking. Some had been unable to access the right care at the right time and others had not been treated with dignity and respect when they most needed it.
In my role as a trustee of Mind, I sit on the External Relations sub-committee and I’m kept abreast of developments in the Crisis Care campaign which has been running since 2011. It has been most heartening to learn about excellent progress that has been achieved since the Crisis Care Concordat was launched in February 2014.
The Mind report on restraint in mental health services across England was published in 2013. I was concerned about the figures that had been revealed under the Freedom of Information Act and in particular the number of prone (face-down restraints) which are associated with increased risk to patients. I was curious to discover what CPFT was doing to address this issue and this led me approach the Clinical Director of adult services. This meeting sparked the inception of project known as PROMISE (Proactive Management of Integrated Services and Environments) Global as we were both concerned about this particular aspect of crisis care.
PROMISE was initiated with a clear focus on understanding the use of Physical Interventions within CPFT.
At inception the emphasis was very much on incident reporting and continuous auditing or quantitative service evaluation. Qualitative research into positive and proactive care quickly grew into a new strand following the publication of the Department of Health guidance in April 2014. Over the course of our journey there have been some key insights:
• We have come to realise that physical intervention is only the tip of the iceberg and as the use of force is on a continuum, all force should be up for scrutiny.
• From examining incidents we moved to thinking about antecedents so the emphasis has shifted to patient experience, which also gives a more positive message.
Many of the antecedents can be avoided if patient experience is enhanced through:
• Person-centred care
• Fulfilled staff
• Healing environments
• Another shift has been from inpatients to integrated pathways. 95% of the patient journey is in the community, thus 95% of lost opportunities for early assessment and intervention is in the community. One of the best way to eliminate reliance on force is for our services to be so proactive that no one gets so unwell that they have to give up the driving seat.
The PROMISE project with its vision to promote dignity by eliminating force in mental health has a wide remit. However, at a local level much of the work we are doing complements and dovetails with the Crisis Care Concordat. The aspiration is to scale up and replicate these local solutions internationally to form a global vision for local agendas.
On 9 October 2015, the PROMISE Charter was signed in Cambridge by organisations across the health and social care arena. The aim is to create seamless pathways of care, a proactive workforce for the future and communities that are more accepting of mental health challenges.
There is still much work to be done to translate a signature into a real change in patient care. Nevertheless, I’m very optimistic that the Crisis Care Concordat and the PROMISE project will go a long way to improve services and bridge gaps.