Reducing injuries from physical intervention

Research emerging from the US has found that a long-established system for restraint training within the care sector has led to a significant reduction in the use of mechanical and physical restraint. UK regulators have shown interest in the Mandt system following the startling findings.

According to the 2023 report, within two years of introducing the Mandt System in 2013, alongside a wider strategy, The Commonwealth of Pennsylvania State Hospital System eliminated mechanical restraint among patients with mental illness and addiction. It also experienced a 23% total reduction in the use of physical restraint over a 10-year period and a 64% reduction in the average time a person was held in physical restraint.

Charlotte Rowe, Practice Manager at Markel Care Practitioners, says: “This research hasn’t yet been replicated in the UK, but it is encouraging because it is one of the first pieces of research, we’ve seen that links intervention with claims and claims reduction. Certain regulators have got hold of this research and while we can’t say it is preferred methodology they are showing a preference for it.”

Safety improvements

The 2023 research study, ‘Effects of Ending the Use of Seclusion and Mechanical Restraint in the Pennsylvania State Hospital System’, 2011–2020 (Psychiatric Services journal), noted significant improvements in safety, despite initial concerns that assaults would increase. The Mandt System focuses on crisis prevention and de-escalation training. It emphasises supporting people, not just their behaviours, while maintaining dignity and respect. It aims to help organisations create places where everyone feels safe.

It says: “Pennsylvania’s ongoing emphasis on staff training, de-escalation techniques, psychiatric emergency response teams, and the multipronged approach … contribute to a person-centred approach to care and treatment with significant benefits to staff and patients. Marked reduction in aggression, patient-to-patient and patient-to-staff assaults, and instances of self-injurious behaviours in the civil hospitals and forensic centres during this period all reinforce the utility of this approach.”

The Mandt System focuses on crisis prevention and de-escalation training. It emphasises supporting people, not just their behaviours, while maintaining dignity and respect. And it aims to help organisations create places where everyone feels safe. It could have benefits around attracting and retaining staff in the UK, where there were 152,000 vacancies in 2022/23, explains Rowe.

The Care Quality Commission requires specialist commissioned services to use certified training and can take regulatory action where staff do not receive the support, training and professional development needed to carry out their responsibilities.

Multiple institutions

The system has been used in the US for some time with impressive results. It was implemented in the Children’s Mercy Hospital in Kansas City in 2019 as part of a multi-pronged effort to address a rise in escalation and staff injuries. It achieved substantial reductions in staff injuries, patient self-harm and the use of restraints on patients with behavioural issues.

Mercy Hospital campuses in Dubuque and Mason City, Iowa, reduced workers’ compensation costs by more than 40% after implementing the system, while the Wisconsin Division of Juvenile Corrections reported a 44% decrease in the use of mechanical restraints and a 32% decrease in the use of force from 2022 to 2023. And between 2022 and 2023 the Children’s Hospital of Richmond reported an 82% decrease in physical restraint.

According to the Pennsylvania study: “Physical restraint is defined as any hands-on control or containment of a person. Mechanical restraint involves the use of any devices to control or contain a person.” Reducing the use of these tactics and focusing on person-centred approaches, such as the Mandt System could have benefits for staff, service users and care providers.

The system offers good potential to improve training practices in the UK although because the system has yet to be fully studied in a UK setting, it’s not yet possible to be certain whether the US success will be replicated or any likely impact on claims.