PROMISE: PROactive Management of Integrated Services and Environments
Co-founders of the Research:
Dr Manaan Kar-Ray, Consultant Psychiatrist, and former Clinical Director of adult services at CPFT
Sarah Rae, CPFT Expert-by Experience and CLAHRC EoE PPI Advisor
PROMISE’s overall purpose was to reduce the use of restraint (with a particular focus on prone restraint), in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT). It aimed to create a framework for supporting staff and services users on the journey of reducing restraint. The project comprised different elements of work, and centred on core values of caring responses to distress, courage to challenge decisions and co-production of novel solutions in the delivery of acute mental health care.
PROMISE was conceived in response to MIND’s 2013 report “Mental Health Crisis Care: Physical Restraint in Crisis” and it’s aims were driven by the guidelines issued from the Department of Health in the “Positive and Proactive Care: reducing the need for restrictive interventions” 2014 document. This set out the expectations for services, but there was very little evidence or direction on how services should achieve these.
The qualitative element of the study used the expertise and wisdom of service users and staff to bridge the knowledge gap, specifically aiming to:
- Increase understanding of subjective experiences of restraint from service users and staff
- Capture the service users’ and staffs’ suggestions for how to reduce restraint
- Explore understanding and views of proactive care from both perspectives
The quantitative part of the study reviewed the numbers of restraint incidents and the different types of restraint used in those incidents (e.g prone restraints which have been linked with causing breathing difficulties, injury and in very rare cases death). This allowed the research team to look for evidence of PROMISE reducing the number of restraints and their severity on inpatients wards in CPFT.
For more information about the study please see PROMISE background, aims and methods.
Findings from the study show that incidents decreased noticeably and increased understanding of restraint use from the perspectives of both staff and service users. This has provided the evidence base for key proactive care initiatives that have been implemented within CPFT. Specifically, the quantitative study found that over a three-year period, CPFT saw a drop (58%) in incidents of face down restrains and all forms of physical interventions, as well as high patient experience scores.
Tracy Dowling, Chief Executive of CPFT: “The PROMISE research work was an award-winning project which made a significant contribution to CPFTs response to the Department of Health’s Positive and Proactive Care Guidance. The ward based initiatives* mapped through the co-produced PROMISE project have been shared and had a positive impact on staff and Trust culture and saw a marked reduction in restraint incidents.
The PROMISE research complemented other aspects of Trust work in this area which has included review and development of policy, training, debriefing support and incident recording and reporting. The Trust is committed to reducing the need for physical interventions and promoting recovery. We are keen to share our learning with others”.
(*see below for examples of the ward-based initiatives used)
From the qualitative part of the project:
- Wilson C, Rouse L. Rae S, & Kar Ray M. Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint. Int. Journal of Mental Health Nursing. 2017. 26: 500–512. doi:10.1111/inm.12382 (Abstract)
- Wilson C, Rouse L. Rae S, & Kar Ray M. Mental health inpatients’ and staff members’ suggestions for reducing physical restraint: A qualitative study. Journal of Psychiatric and Mental Health Nursing. 2018. [Epub ahead of print]. doi:10.1111/jpm.12453 (Abstract)
From the quantitative part of the project:
- , et al. PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare
The project won the highly competitive ‘Strengthening the Foundations’ category at Patient Experience Network National Awards (PENNA) and features as part of a CQC produced resource evidencing examples of good practice relating to the reduction in use of restrictive practices: Mental Health Act – A focus on restrictive intervention reduction programmes in inpatient mental health services.
For further information on this project, please contact Sarah Rae at firstname.lastname@example.org.
Examples of the initiatives used in CPFT:
click on each image for the full document