Reducing restrictive practice:Developing and implementing behavioural support plans

The importance of reducing restrictive practices in mental health settings is an issue of national importance. This article details the development and implementation of bespoke behavioural support plans at a large London mental health trust. The tool was developed and piloted by staff on a male psychiatric intensive care unit (PICU), caring for patients with complex mental and physical health needs. These patients present with challenging and acutely disturbed behaviour which cannot be managed in an open setting. The behavioural support plans are based on a biopsychopharmacosocial approach in conjunction with an appraisal of the patient's current environment and past incidents, to examine contributing factors to the patient's behaviour. This information is used to form a management plan, including primary, secondary and tertiary interventions, thus proactively reducing tertiary restrictive practices such as restraint, rapid tranquilisation and seclusion. The plans are now used trust-wide with patients who have complex needs. As a result of the success of this intervention, a second pilot is now underway, where behavioural support plans have replaced traditional care planning. </jats:p