Seeing hope in a less restrictive future

Here is a word for you: ‘stobuften’ – it’s a German word and has characters and letters that being generally inept and not particularly computer literate, I can’t reproduce here. However, it is the word’s meaning that is important. It refers to the practice of ‘shock ventilation’ – opening a few windows wide for no more than a few minutes. It is something that happens in this household every single day. All the windows upstairs are opened, as wide as they will go, to ‘air the house’. It happens against the backdrop of creaking hot water pipes and radiators, as the central heating system tries (vainly) to compensate for the sudden loss of heat in the house. In Germany, this is a common practice. In this house, it is not me who opens the windows in this way…

Now don’t get me wrong. I’m all for fresh air, and love being outside, as much as I can. Whatever the weather, if I can be outside, I will. I love the sense of freedom I get from being outside walking, gardening and more recently, slowly passing through countryside on our narrowboat. Freedom, or rather the ability to make decisions about what we might do, was something we focused upon in our Board Development Day last week.

We were joined by colleagues from our Human Rights and HOPE(S) team. The HOPE(S) model* is a human rights approach, developed by our colleagues at the Mersey Care NHS FT. Its aim is to work at reducing the time service users spend in segregation. Being in seclusion for long periods of time is known to be counter-productive to good mental health and, wherever possible, should be avoided. The team shared a video of someone who, whilst receiving care for her mental illness, had spent a great deal of her time in seclusion. It was a very challenging video to watch. The negative impact on the patient’s mental health and wellbeing was clearly profound.

Our HOPE(S) team is a result of an NHS-funded national roll out of the roles, training and approach that brings together healthcare professionals, service users and carers. It was good for the Board to see the enthusiasm and commitment the team had for training and supporting others to find compassionate ways to reduce the use of restrictive practices.

The Board development session reminded us that protecting peoples’ human rights is everyone’s business. Over a 90-minute period, and using an interesting and powerful approach, the facilitators took us through what protecting the human rights of the people we care for, looks and feels like. The first exercise involved us being given a piece of white paper, and a stubby crayon each. Some of the crayons were white. We were asked to list five things that were important to us in our lives. Next, we were asked to swap our papers with the person sitting beside us, and to then strike out three of the things on each of the lists.

It was a simple and effective way of demonstrating how easy it might be to take something that was precious away from us. The next exercise was even more vivid. We were joined by three members of our Prevention and Management of Violence and Aggression (PMVA) team. PMVA is a structured prevention-led approach used to reduce the risk of violence and manage aggressive behaviour, safely, lawfully and ethically.

The team asked for a volunteer, and our Chief Medical Officer (CMO) duly stepped up. He was successfully, and safely restrained. Although he wasn’t violent, the team showed how they could escalate their approach, whilst imagining that he was becoming increasingly more aggressive. Importantly, throughout the exercise, the team leader used calm reassurance, as she and her team restrained our CMO. Likewise, throughout the exercise, they ensured his dignity was protected. It was an impressive demonstration of what is possible to achieve in difficult situations, with the right training, teamwork and calm approach.

It was also a wonderful insight into how our Trust-wide ambition to reduce restrictive practices of all kinds could be achieved. There is a way to go, but goodness, we have a great team leading on delivering this ambition. The Board Development Day was just as it should be, stimulating and refreshing - rather like the impact of wide-open window on an arctic cold morning might have.

 

*Here is the Mersey Care FT description of the HOPE(S) model:

• It encourages teams to Harness the system through key attachments and partnerships
• Create Opportunities for positive behaviours, meaningful and physical activities;
• Identify Protective and preventative risk and clinical management strategies;
• Build interventions to Enhance the coping skills of both staff and people in services
• Whilst engaging in these tasks clinical teams and the System needs to be managed and developed to provide support throughout all stages of the approach.