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Improving communication can reduce restraint

Published: 27 June 2019 at 10:42

Dr Ceri Wilson

Work incorporating mental health patient and staff suggestions wins Paper of the Year

Research exploring mental health patients’ and staff members’ suggestions for reducing physical restraint has won paper of the year 2018 in the Journal of Psychiatric and Mental Health Nursing.

Working with Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), the research team from Anglia Ruskin University (ARU) found that improving communication and relationships between staff and patients, making staffing‐related changes, improving busy ward environments and providing patient activities are essential to reduce restraint in mental healthcare.

The qualitative study is part of PROMISE (PROactive Management of Integrated Services and Environments) - an award-winning project developed by frontline staff and patients at CPFT to change culture and reduce physical interventions in mental health settings. 

This project was funded and supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England (NIHR CLAHRC EOE), hosted by CPFT.

Dr Ceri Wilson, co-author and senior research fellow at ARU, said:


“There is growing recognition of the negative consequences from high levels of restraint in mental healthcare settings across the world. The mental health staff and patients we worked with highlighted how to reduce restraint by improving communication and relationships between staff and patients, managing staffing – by recruiting more front line staff, and freeing up more patient-facing time, while improving the environment and space with increased activities and distraction. 

“However, fundamental issues related to understaffing, high staff turnover, and lack of time/resources need addressing in order for suggestions to be successfully implemented.

“This award is a great acknowledgement of an important and timely research study conducted in partnership with Anglia Ruskin University and CPFT.”


Over three years of running PROMISE, the Trust achieved a remarkable drop (58%) in incidents of face down restrains and all forms of physical interventions, as well as high patient experience scores. Continued research is needed to establish the best ways to reduce physical restraint, find practical approaches to improve ward facilities and release more time for staff to spend with patients.

Co-author and CPFT expert-by-experience Sarah Rae said:


“The qualitative research was conducted because there was little guidance for what proactive care entailed at the frontline. The key themes from this study fed into the wider project which led to a marked reduction in restraint incidents. In particular, the study findings informed the ward-based initiatives which had a positive impact on Trust culture.”

Nationally, the Care Quality Commission (CQC) has highlighted how PROMISE has created a positive and therapeutic culture across mental health wards at CPFT and reduced the need for restrictive interventions. The scheme features in this CQC guide designed to help mental healthcare providers improve support for patients.

View the full paper: Mental health inpatients’ and staff members’ suggestions for reducing physical restraint: A qualitative study