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Training fuels fall in patient restraint at secure hospital

A secure hospital has seen a significant drop in its physical restraint of patients - helped by adopting non-abusive intervention training of its staff.

St Magnus in Surrey is an 86-bed hospital caring for adult men, many of whom display challenging behaviour stemming from conditions such as mental illness, personality disorder, and cognitive impairment.

NAPPI uk has been training its 220-plus staff since November 2017 - with an ethos seeking to diffuse situations before they escalate to violence, but also teaching less invasive techniques if restraint is needed as a last resort.

The number of times restraint has been used has tumbled as a result. Between April and June 2017 there were 44 incidents of violence leading to 28 restraints. In the same period in 2018 there were 27 incidents and only one restraint.

Hattie Randall, a qualified nurse, manager and lead NAPPI trainer at St Magnus, said: "The patients' behaviour can be challenging because of their conditions and can lead to violence through paranoia, confusion or aggression."

"But since we teamed up with NAPPI the use of restraint has reduced significantly."

"Staff are trained to get to know the patients, and think 'out of the box' a bit more."

"We use NAPPI's behaviour support plans to help the patients by using distractions such as going for a walk or a cuppa, or a visit to our activity rooms, to stop things escalating."

"If we do need to restrain - for example if a patient refuses essential anti-psychotic medication or if there is danger of violence towards staff, other patients or self-harm - we use minimal staff to make it less intimidating",
said Ms Randall.

"Having five or six people coming to restrain you must be scary for the patient, so we try to use only two or three - and we also look at whether we need to restrain at all. If a patient is throwing chairs and there is no danger to people, we might let them express themselves instead of restraining."

"Staff are given monthly NAPPI training at levels appropriate to their needs."


Ms Randall added: "The CQC were impressed with the change of techniques. NAPPI has given staff more knowledge and tools to use in very difficult situations."

St Magnus has a Low Secure Unit and Locked Recovery Service facilities and is one of the largest units providing inpatient care to older adult men in the UK.

In February 2018 St Magnus was thrilled to be given an outstanding rating by the CQC. The glowing CQC report praised the quality of care, training and leadership, adding "visiting clinicians remarked on how well treated the patients were" and pointing out that staff felt "empowered and motivated to do their jobs well."

NAPPI (Non-Abusive Psychological and Physical Intervention) uk is a leading provider of training services in the care sector specialising in managing challenging behaviour.



NAPPI regional trainer and partnership development lead Tony Differ said: "It is all about helping staff understand patients, why individual's behaviour may occur, and how to respond to ensure it makes things better rather than worse."

"It can take carers years to earn the trust of people they are supporting, but it can be lost in seconds if you hurt them. If restraint is needed we can teach techniques that can hold someone without pain and enabling carers to re-engage with them straight afterwards."


Tony was pleased the CQC had recognised the changes NAPPI training had helped bring about at St Magnus.

"There is nothing more rewarding than seeing we have helped an organisation change lives," he added.

NAPPI uk Ltd, 64 Falsgrave Road, Scarborough, North Yorkshire, YO12 5AX

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