Using a short-term risk assessment and compassion focused staff support groups to reduce restrictive intervention use in a secure mental health service.

Abstract

Objectives: The aim of the current study was to introduce two interventions to reduce restrictive practice use in a UK-based secure mental health service. The interventions were a short-term risk assessment called the Dynamic Appraisal of Situational Aggression (DASA), and staff support groups based on the Compassion Focused Therapy model (CFSS groups). Intervention selection was guided by a recently published, trauma-informed model of restrictive practice use, the Maintenance Model of Restrictive Practices.

Methods: Five secure mental health wards were included in the study and restrictive practices were compared pre and post intervention for each ward. Owing to limitations in the available data, we were limited in the research design and analyses that could be used. Descriptive statistics were used to compare restraint frequency and short-, medium- and long-duration seclusion episodes pre and post intervention, per ward.

Results: DASA was associated with some reductions in restrictive intervention use on some wards, but this was inconsistent. Similarly, CFSS groups were associated with some limited reductions in restrictive intervention use, but this was again inconsistent. When the DASA was introduced in addition to CFSS groups, reductions in physical restraints and medium and long-duration seclusion episodes were observed.

Conclusions: Short-term risk assessment and compassion focused staff groups were associated with reductions in restrictive practice use across some secure mental health wards, but this was inconsistent. To our knowledge, this is the first study that has addressed staff emotional wellbeing in an attempt to reduce restrictive practice use. The findings provide some tentative support for the Maintenance Model of Restrictive Practices.