Exorcising restraint: reducing the use of restrictive interventions in a secure learning disability service

Abstract

Purpose The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the national Positive and Safe programme. Design/methodology/approach The strategy was comprised of three primary interventions – Safewards, positive behavioural support and data-informed practice – and utilised a programme management approach to ensure effective delivery. Baseline measures were collected from 12 months of data prior to implementation of the programme and the frequency of each category of restrictive intervention was then measured prospectively on a monthly basis throughout the duration of the programme. Findings Upon completion of the programme the following results were achieved: elimination of prone restraint – elimination of mechanical restraint – 42 per cent reduction in general use of restraint – 42 per cent reduction in use of seclusion – 52 per cent reduction in rapid tranquilisation. Originality/value The paper adds to the growing body of evidence that carefully designed interventions can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the need for a stable workforce is considered.