Patient safety is at the heart of the care we provide. Sometimes though, staff may have to use a Restrictive Intervention to maintain the safety of patients and staff. This may include physically holding you, seclusion, long-term segregation, or using medication to help manage your behaviour.

The model we use to support the use of any Restrictive Interventions is known as De-escalation, Management and Intervention (DMI)

The training of this model is delivered to all staff by in-house trainers who have lots of experience of working on the wards within MPFT.

We believe that patients should be able to access as much information as they can about all aspects of their care, including physical intervention.

The DMI model encourages patients and staff to discuss this topic as openly and honestly as possible. Patients are encouraged to be a part of the safety planning process as much as possible if physical interventions are to be used.

What is De-escalation, Management and Intervention (DMI)

It is a model used for the management of non-physical and physical assault and challenging behaviour in mental health and learning disability care services.

Challenging behaviour can be that people harm themselves, harm others, or damage property. This type of behaviour can be for lots of different reasons, mental ill-health, frustration, being upset and angry, scared, or personal circumstances.

The model tries to involve patients as much as possible when managing their behaviour. This means having discussions with staff and pre-planning any sort of Restrictive Intervention. For example:

  • let me go to a quieter area of the ward
  • if I have to be held, do this in a seated position
  • if I have to have medication administered I will stand up to take oral medication

We understand that at times people do get angry and upset and that these emotions need to be vented, but we also recognise when this is becoming unsafe for everyone else, and a physical intervention may have to be used.

 

So how does DMI work?

It works by looking at how, when, and why behaviours escalate.

So for example:

  • what makes you angry?
  • how does your illness make you think and act?
  • what do you experience when you are unwell and how does this impact on your coping mechanisms?
  • what can I do to manage my behaviours and keep myself and others safe?
  • what can the staff do to help me manage my behaviours and keep everyone safe?

By exploring and asking these types of questions and looking at solutions we can hopefully reduce the risk of actions and behaviours escalating. Both staff and patients can put in place coping mechanisms early, avoiding any sort of physical intervention.

DMI should be used:

  • as a planned response
  • in a least restrictive way
  • within the boundaries of law:
    • Health and Safety at Work Act
    • Mental Health Act
    • Mental Capacity Act
    • Human Rights Act
    • Policies and Procedures of MPFT NHS Foundation Trust

 

When is a Restrictive Intervention used?

The decision to use any form of Restrictive Intervention is not an easy decision to make.

Staff would use Restrictive Interventions when there is a clear and apparent risk to everyone present and all other options have been exhausted (talking, negotiating, etc...)

If Restrictive Interventions have to be used then it will be used in a way that is least restrictive, preferably planned and used at a level appropriate to the risk being presented.

 

What happens after a Restrictive Intervention is used?

Staff will follow all the policies and procedures after a Restrictive Intervention has been used.

A discussion should also take place with you to discuss what happened and explore the reasons why. This is very useful to look at planning any possible future interventions:

  • could we do things differently
  • what are your wishes
  • what could you do differently i.e. speak to staff earlier, utilise other coping mechanisms or distraction. This is called an Advance Statement and is a way of recording your wishes.
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