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Best Practices for Reducing the Use of Coercive Measures

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The Use of Coercive Measures in Forensic Psychiatric Care

Abstract

Coercive measures in forensic metal health settings are utilised in the management of disturbed, aggressive or violent behaviour and there are always moral issues, even when these types of intervention are legitimised. Although coercive measures are routinely utilised when all other intervention options fail, it is important to acknowledge that occasionally patients with predisposing factors for violence do not always respond positively to de-escalation attempts, and the violence that nurses and other professionals face is sometimes instantaneous, extreme and intense; so it is unrealistic to believe that coercive measures are totally unnecessary or uncalled for. Therefore, while we strive to reduce their use to a minimum, they will continue to be considered as planned or unplanned intervention options.

In 2014, the United Kingdom Government guidance ‘Positive and Proactive Care; reducing the need for restrictive interventions’ (Department of Health (DH). Positive and Proactive Care: Reducing the need for restrictive interventions. http://www.tinyurl.com/o2h8rxs, 2014) was published to ensure that care providers implemented least restrictive practices in their services. This initiative was further supported by the Mental Health Act (Code of Practice. TSO, Norwich, 2015) and the National Institute for Clinical Excellence [NICE] (Violence and aggression: Short-term management in mental health, health and community settings. http://www.nice.org.uk/guidance/ng10, 2015). These drivers inspire positive changes as all NHS Trusts must evidence a Restrictive Intervention Reduction Programme. Prevention and early intervention strategies rely on promoting least restrictive ways of managing a patient’s behaviour by reducing risk factors for violence and aggression. To achieve this and reduce the use of coercive measures, protective factors that promote the safety and well-being of patients must be implemented, and individuals should be treated with understanding and acceptance.

To begin to reduce coercive measures such as physical restraint, seclusion and chemical restraint, and identify and introduce best practice initiatives, healthcare professionals should gain insight into the theories around causes of violence and aggression and understand factors that may pre-empt or exacerbate violent episodes. A review of the background of violence and aggression management and staff training in forensic mental health settings clearly shows how practices have evolved and developed so far. An evaluation of staff training and practice models gives insight into progress and development. Change management models and methods are identified to help leaders drive best practice changes. Current drivers and guidance for healthcare providers within the NHS and the Private Sector are highlighted with best practices and innovative projects aimed at reducing the use of coercive measures in response to the guidance.

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Authors and Affiliations

  1. Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK

    Jacqueline Ewington

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  1. Jacqueline Ewington
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Correspondence to Jacqueline Ewington .

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Editors and Affiliations

  1. University of Nottingham, Nottingham, United Kingdom

    Birgit Völlm

  2. Department of Forensic Psychiatry, Psychiatric Hosp.of the Univ. of München, München, Germany

    Norbert Nedopil

Appendices

Appendix 1: Public Health Model

figure a

Appendix 2: National Decision Making Model (NDM)

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Ewington, J. (2016). Best Practices for Reducing the Use of Coercive Measures. In: Völlm, B., Nedopil, N. (eds) The Use of Coercive Measures in Forensic Psychiatric Care. Springer, Cham. https://doi.org/10.1007/978-3-319-26748-7_16

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