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Standards for Forensic Mental Health Services:
Low and Medium Secure Care
2016
Editors: Sam Holder and Renata Souza
Publication ref: CCQI234
Table of Contents Foreword ......................................................................................... 5
Developing the Standards for Forensic Mental Health Services (low and
medium secure care) ........................................................................ 6
Standards for Forensic Mental Health Services: Low and Medium Secure Care ............................................................................................... 7
Patient Safety .................................................................................. 8
Physical Security ........................................................................... 8
Procedural Security ...................................................................... 10
Relational Security ....................................................................... 11
Safeguarding .............................................................................. 11
Patient Experience .......................................................................... 12
Patient Focus .............................................................................. 12
Family and Friends ....................................................................... 14
Environment and Facilities ............................................................ 15
Clinical Effectiveness ....................................................................... 18
Patient Pathways and Outcomes .................................................... 18
Admission ................................................................................ 18
Treatment and Recovery ............................................................ 19
Medication ............................................................................... 20
Leave and Discharge ................................................................. 21
Physical Healthcare ...................................................................... 23
Workforce ................................................................................... 25
Supervision and Support ............................................................ 26
Training ................................................................................... 26
Governance ................................................................................... 28
References .................................................................................... 30
Appendix 1: Development of core standards for inpatient services10 ...... 31
Appendix 2: Acknowledgements ....................................................... 32
Appendix 3: Standard consultation attendees..................................... 33
Appendix 4: Advisory Group ............................................................ 34
Appendix 5: QNFMHS Project Team, Patient reviewers and Family and
Friends Representatives .................................................................. 35
Appendix 6: Glossary and Abbreviations ............................................ 36
5
Foreword
I am pleased to welcome the new edition of the standards for the Quality Network for Forensic Mental Health Services (QNFMHS).
In creating this new set of standards, we welcomed the opportunity to reflect on a decade of successfully implementing quality improvement
practices in forensic services. This presented us with the opportunity to harmonise and enable improved coherence across the forensic mental
health pathways. As part of the consultation period to revise and update the standards, we
received invaluable input from staff from medium and low secure services, patients, family and friends, managers and commissioners. We have also
listened to feedback from member services throughout the low and medium secure networks’ review cycles and annual forums.
We have strengthened the standards by making them more focused on the delivery of high quality care. Harmonisation of our secure standards
supports an approach in keeping with how forensic care pathways operate and the strategic objectives stated in the Five Year Forward View1. As is evident in this new set of standards, we are committed to patients and their
family and friends with emphasis on their experiences of care in forensic mental health services.
The standards and the review process will provide a more robust assurance framework for services to drive quality improvement further both locally
and nationally. We hope that members of the QNFMHS will find these standards helpful and we also look forward to working with you in sharing
related good practice across our network. The success of the Quality Network depends on the continued commitment
and engagement of members and I would like to take this opportunity to thank you for all your support.
Dr Quazi Haque Chair, Advisory Group
1 https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
6
Developing the Standards for Forensic Mental
Health Services (Low and Medium Secure Care)
These standards have been developed in consultation with the member
services of the Quality Network for Forensic Mental Health Services
(QNFMHS), patients, family and friends and other key stakeholders. They
are based on the Standards for Medium Secure Services (2014) and the
Standards for Low Secure Services (2012), along with the Royal College of
Psychiatrists Standards for Inpatient Mental Health Services (2015).
1. Mapping exercise
The first stage of this process was to map the Standards for Medium Secure
Services (2014) and the Standards for Low Secure Services (2012) to
remove repetition and identify those standards which could be phrased in a
more measurable way. The second stage involved mapping these standards
against the Royal College of Psychiatrists Standards for Inpatient Mental
Health Services (2015). The purpose of this stage was to ensure that where
the inpatient standards were applicable to Forensic Services the agreed
wording was used.
2. Standards consultation event
The Quality Network for Forensic Mental Health Services held a consultation
event on 17 March 2016. The event was attended by representatives of multidisciplinary teams, patients and family and friends, as well as other
key stakeholders (see Appendix 3). Delegates worked in small groups and were asked to:
Agree on the applicability of the standards for the forensic pathway;
Remove any standards no longer required; Add in any missing standards; and
Edit existing specialist standards to ensure clarity and measurability.
3. Electronic consultation
On the basis of the feedback provided at the consultation event, a second
draft of the revised standards was developed. In April 2016 the draft was
sent electronically to all QNFMHS contacts including: advisory group
members, family and friends representatives, patient reviewers, delegates
of recent training events and workshops, NHS England representatives, and
member services via the MSU and LSU email discussion groups. This time
we asked people to focus in on those standards where additional guidance
was needed to ensure clarity and review the new standards which had been
added.
7
Standards for Forensic Mental Health
Services: Low and Medium Secure Care
No. Standard text and guidance Source
document
8
Patient Safety –
Physical Security
1
There is a Physical Security Document (PSD) that describes the
physical security in place and clearly defines the secure perimeter line.
Guidance: The PSD should have a central role in describing how the building
and security elements work. It should describe the security
systems in place to a level that it can be used as a training aid. It should describe the inner and outer security of the building
and how they relate. This is the process for ensuring that the security process in controlling the environment is well described.
1
2
The secure perimeter is in line with the planning specification for the service, is protected against climbing and is easily observable.
Guidance: The secure external perimeter is:
formed by buildings formed by buildings connected with fencing joins the reception and surrounds the remainder of the unit
surrounds the whole unit
Where fencing is used to form all or part of the secure perimeter it must be a minimum of 5.2m in height for medium secure and 3m in height for low secure and should be BS358 weld mesh (3mm diameter
and 13mm centres vertically and 75mm centres horizontally).
Roof lines are protected against climbing through: gooseneck capping flexible secure topping
alarm systems with an immediate planned response
3
3
There is a daily recorded inspection of the perimeter and programme
of maintenance specifically for the perimeter, with evidence of immediate action taken when problems are identified.
2, 4
4
There are controlled systems in place to manage access and egress through all doors and gates that form part of the secure perimeter.
Guidance: Core design should be part of the PSD and included as part of the
inner and outer perimeter.
3
5
Access to the secure service for visitors, staff and patients is via an
airlock.
Guidance: Both doors must not be able to open at the same time.
6, 7
6
In outside areas of the service (within the secure perimeter) permanent furniture is fixed; doors, lighting postings, fixings, and other items used within outside spaces should be prevented from use
as a climb aid.
3, 8
7
Windows that form part of the external secure perimeter are set
within the building masonry, do not open more than 125mm and are designed to prevent the passage of contraband.
3, 8
No. Standard text and guidance Source
document
9
8
The reception/control room: is within the secure area or forms part of the secure external
perimeter is fully operational (manned 24 hours per day 7 days week) or can
be made fully operational in the case of an emergency
3, 8
9
There is a key management system in place which accounts for all
secure keys/passes including spare/replacement keys which should be held under the control of a senior manager.
2, 8
10
Secure pass keys (including all types referenced in the Environmental Design Guide) are: on a sealed ring
secured to staff at all times within the secure perimeter prevented from being removed from the secure perimeter
Guidelines: The term ‘key’ can include any of the following systems:
electro-mechanical traditional manual keys
magnetic swipe card proximity readers
biometric readers
3, 8
11
There is a process to ensure that:
The list of approved key holders is updated monthly with training dates and leavers
Keys are only issued upon the presentation of valid ID Keys are not issued until a security induction has been completed
3, 8
12 Where CCTV is in use, there should be passive recording of the perimeter, reception frontage and access from the secure area to
reception.
8
13 Prohibited, restricted and patient accessible items are risk assessed,
controlled and monitored. 3, 7
14 There is a designated security lead with responsibility for security within the service. The lead has direct links to those with accountable
responsibility for the service.
7
No. Standard text and guidance Source
document
10
Patient Safety – Procedural Security
15
There is a procedural security index document (PSID) in place that includes:
Observation Possessions
Prohibited items Control, issue, checking and maintenance of keys and locks Access to and use of the internet containing specific advice
around the appropriate use of social networking sites, confidentiality and risk
Anti-bullying policy (for those who are bullying and those who are bullied)
Prevention of suicide and management of self-harm
Smoking cessation Patients’ monies
One to one working with patients including feeling safe and appropriately skilled when escorting patients on leave
Absent without leave
Agreed protocol with local police, which ensures effective action on incidents of criminal activity/harassment/violence
Managing patients’ use of electronic equipment Visiting including procedures for:
- children
- unwanted visitors Searching
Restrictive practice
Guidance: These documents may be separate policies or could form part of other policies if these elements are clearly identifiable.
7, 8, 10
16 Policies included in the PSID describe the mechanisms and procedures expected in practice.
QNFMHS
Experts Consensus
2016
17 There is an audit programme in place which monitors compliance with policies.
QNFMHS
Experts Consensus
2016
18 Policies, procedures and contingency plans are reviewed, and updated where required, at the point of material change to the service,
incident, and every three years as a minimum.
4, 7
No. Standard text and guidance Source
document
11
Patient Safety – Relational Security
19 There are clear and effective systems for communication and handover within and between staff teams.
2, 8, 9
20 There is an induction and annual training programme for all staff that specifically addresses issues of relational security and is supported by
the use of See, Think, Act 2nd Edition.
2, 8, 9
21
There are regular reflective multi-disciplinary forums where people
have the opportunity to discuss the concerns they have and other issues of relational security.
2, 8, 9
22
There is a process in place to monitor how the service is performing against items relevant to relational security and an action plan is in
place to address any issues raised. Guidance: Relevant issues are identified using the relational security
explorer wheel, noted in handovers and audited.
8, 9
Patient Safety –
Safeguarding
23
Staff members follow inter-agency protocols for the safeguarding of
adults and children. This includes escalating concerns if an inadequate response is received to a safeguarding referral.
10
24
On admission, a record is made for each patient of any children known to be in their social network, their relationship to those children and any known risks whether or not reflected in convictions.
Guidance: In the case of emergency admissions this should be
conducted as soon as possible.
8
25
There is a designated safeguarding lead for both children and adults
who is able to give advice and ensure that all safeguarding issues are raised and resolved, in line with local policy.
2, 8
26 There is a system in place to respond to themes and trends in safeguarding referrals and shared learning.
8
No. Standard text and guidance Source
document
12
Patient Experience –
Patient Focus
27
On admission to the service, staff members introduce themselves,
other patients and show them around.
Guidance: This may also include the use of a ‘buddy system’ prior to admission.
10
28
Individual staff members are easily identifiable (for example, by wearing appropriate identification).
Guidance: This could be a photo ID or ‘Hello my name is ….’ badge.
10
29
The patient is given a ‘welcome pack’, or introductory information, at
the first appropriate opportunity that contains, at a minimum, the following:
A clear description of the aims of the service The current programme and modes of treatment The service team membership
Personal safety on the service The code of conduct on the service
Service facilities and the layout of the service What practical items can and cannot be brought in Clear guidance on the smoking policy in smoke-free hospitals
and how to access smoking breaks off the hospital grounds Resources to meet spiritual, cultural and gender needs
10
30 Detained patients are given verbal and written information on their rights under the Mental Health Act (or equivalent) and this is
documented in their notes.
10
31
Patients are given verbal and written information on:
• Their rights regarding consent to care and treatment • How to access advocacy services • How to access a second opinion
• How to access interpreting services • How to raise concerns, complaints and compliments
• How to access their own health records
10
32
All information is provided in a format which is easily understood by
patients. Guidance: Information can be provided in languages other than
English and in formats that are easy to use for people with sight/hearing/cognitive difficulties or learning disabilities. For
example, audio and video materials, using symbols and pictures, using plain English, communication passports and signers. Information is culturally relevant.
10
33
Confidentiality and its limits are explained to the patient and carer on admission, both verbally and in writing.
Guidance: For carers this includes confidentiality in relation to third
party information.
10
34 Patient issues raised with an independent advocate are addressed
with relevant staff and outcomes are fed back to patients. 8
35 Patients are offered a staff member of the same gender as them,
and/or a chaperone of the same gender, for physical examinations. 10
No. Standard text and guidance Source
document
13
36
Patients and carers are offered written and verbal information about the patient’s mental illness.
Guidance: Verbal information could be provided in a one to one
meeting with a staff member, a ward round or in a psycho-education group.
10
37 Patients’ preferences are taken into account during the selection of medication, therapies and activities, and are acted upon as far as possible.
10
38
There is a minimum of one minuted community meeting per month that is attended by patients and staff members.
Guidance: This is an opportunity for patients to share experiences, to
highlight issues on the service and to review the quality and provision of activities with staff members.
10
39
Patients have access to relevant faith-specific materials and facilities that are associated with cultural or spiritual practices.
Guidance: Covered copies of faith books, access to a multi-faith room.
10
40
Patients and their carers (with patient consent) are helped to
understand the functions, expected outcomes, limitations and side effects of their medications and to self-manage as far as possible.
10
41
Patients and their carers are given the opportunity to feed back about their experiences of using the service, and their feedback is used to
improve the service. Guidance: This might include patient and carer surveys or focus
groups.
10
42 Patients are consulted about changes to the service environment. 10
43
Patients are treated with compassion, dignity and respect.
Guidance: This includes respect of a patient’s race, age, sex, gender reassignment, marital status, sexual orientation, maternity, disability
and social background.
10
44 Patients feel listened to and understood by staff members. 10
45
Patients are provided with meals which offer choice, address nutritional/balanced diet and specific dietary requirements and which are also sufficient in quantity. Meals are varied and reflect the
individual’s cultural and religious needs.
10
No. Standard text and guidance Source
document
14
Patient Experience – Family and Friends
46
The team follows a protocol for responding to carers when the patient does not consent to their involvement.
Guidance: There should be a clearly written process in place, which
may be embedded within existing policies or procedures.
10
47 Carers are involved in discussions about the patient’s care and
treatment planning (with the consent of patients). 10
48 Carers are advised on how to access a statutory carers’ assessment,
provided by an appropriate agency. 10
49 Carers are offered individual time with staff members to discuss
concerns, family history and their own needs. 10
50
The team provides each carer with carer’s information.
Guidance: Information is provided verbally and in writing (e.g. carer’s pack). This includes the names and contact details of key staff
members at the service. It also includes other local sources of advice and support such as local carers' groups, carers' workshops, advocacy
services and relevant charities.
10
51
Carers have access to a carer support network or group. This could be
provided by the service or the team could signpost carers to an existing network.
Guidance: This could be a group/network which meets face-to-face or communicates electronically.
10
52 Patients go on section 17 leave into the care of carers, only with carer agreement and timely contact with them beforehand.
10
No. Standard text and guidance Source
document
15
Patient Experience – Environment and Facilities
53 The main entrance where visitors are expected to wait is welcoming, has comfortable seating and provides a positive first impression.
8
54 The patient and staff environment is homely, light, clean and bright. 7, 10
55 There are lockable facilities (with staff override feature) for patient’s personal possessions with maintained records of access.
4, 7
56 Bedrooms have patient operated privacy locks that staff can override
from the outside. 8
57 Patient bedroom and bathroom doors are designed to prevent holding,
barring or blocking. 4, 7
58
Doors in rooms used by patients have observation panels with
integrated blinds/obscuring mechanisms. These can be operated by patients with an external override feature for staff.
4, 7
59 Patients are able to personalise their bedroom spaces. 10
60
The service has at least one bathroom/shower room for every three
patients.
Guidance: Services built after 2011 should provide en-suite facilities as specified in the Environmental Design Guide. Older buildings should have an established maintenance programme working towards this.
10
61 Patients can wash and use the toilet in private. 10
62 Laundry facilities are available to all patients. 10
63
The service has dedicated spaces for patients within the secure
perimeter for: • Education • Occupational and psychological therapy
• Tribunal suite • Library/reading
• Multi-faith room • Physical exercise • Primary health provision
• Self-catering/cooking • Dining
• Shop/café
8
64
All patients can access a range of current resources for entertainment,
which reflect the service’s population. Guidance: This may include recent magazines, daily newspapers,
board games, a TV and DVD player with DVDs, computers and internet access (where risk assessment allows this).
10
65
The environment complies with current legislation on disabled access.
Guidance: Relevant assistive technology equipment, such as hoists and handrails, are provided to meet individual needs and to maximise independence.
10
66 Patients can make and receive telephone calls in private. 10
67 There is a facility for patients to video-conference. 8
No. Standard text and guidance Source
document
16
68
There are clear lines of sight to enable staff members to view patients. Measures are taken to address blind spots and ensure
sightlines are not impeded.
Guidance: For example by using mirrors or CCTV.
10
69 Furnishings minimise the potential for fixtures and fittings to be used
as weapons, barriers or ligature points. 4, 7
70
There is a staff alert system in place.
Guidance: Staff call button/personal alarms are available to all staff, patients and visitors within the secure perimeter.
10
71
Staff members and patients can control heating, ventilation and light.
Guidance: For example, patients are able ventilate their rooms through the use of windows and have access to light switches and can
request adjustments to control heating.
10
72 There is an easily observable and secure treatment and dispensary
room. 8
73 The service has at least one quiet room other than patient bedrooms. 10
74
There is a designated area or room (de-escalation space) that the team may consider using, with the patient’s agreement, specifically
for the purpose of reducing arousal and/or agitation. Guidance: This should be appropriately furnished for the use of de-
escalation.
10
75
In services where seclusion is used, there is a designated room that
meets the requirements of the Mental Health Act Code of Practice.
Guidance: The room should: allow for communication with the patient when the patient is in
the room and the door is locked, e.g. via an intercom
include limited furnishings which should include a bed, pillow, mattress and blanket or covering
there should be no apparent safety hazards have robust, reinforced window(s) that provide natural light
(where possible the window should be positioned to enable a view
outside) have externally controlled lighting, including a main light and
subdued lighting for night time have robust door(s) which open outwards have externally controlled heating and/or air conditioning, which
enables those observing the patient to monitor the room temperature
not have blind spots and alternate viewing panels should be available where required
have a clock visible to the patient from within the room, and
have access to toilet and washing facilities
5, 10
76
There is a dedicated room for visitors within the secure perimeter.
Guidance: There is a room which is identified for visits to take place,
this room can be used for other purposes if not booked for visits.
4, 7
No. Standard text and guidance Source
document
17
77
The service is able to safely facilitate child visits whenever appropriate, with appropriate facilities such as toys, books.
Guidance: The children should only visit if they are the offspring of or
have a close relationship with the patient and it is in the child’s best interest to visit.
10
78 There are lockers for visitors away from patient areas to store prohibited or restricted items whilst they are in the service.
4, 7
79
There are facilities for patients to make their own hot and cold drinks and snacks.
Guidance: Facilities should be accessible by patients unless individual risk assessments dictate otherwise.
10
80
Patients are able to leave the ward area to access safe outdoor space every day.
Guidance: This includes court yards, secure gardens or utilising leave.
10
81 Lockers are provided for staff away from the patient area for the storage of any items not allowed within patient areas (which are locally determined).
4, 7
No. Standard text and guidance Source
document
18
Clinical Effectiveness –
Patient Pathways and Outcomes
Admission
82 There is a clinical model that describes the purpose of the service and details the clinical approach in relation to key therapeutic outcome areas.
8
83
Clear information is made available, in paper and/or electronic format, to patients, carers and healthcare practitioners on:
A simple description of the service and its purpose Admission criteria
Clinical pathways describing access and discharge Main interventions and treatments available How the service involves patients and their friends and family
Contact details for the service
10
84
There is a medical on-call arrangement in place which enables the
service to: Respond swiftly to psychiatric emergencies
Achieve national standards for the monitoring of patients in seclusion
Fulfil the requirements of the Mental Health Act Code of Practice
Guidance: An identified doctor should be available at all times to
attend the service, including out of hours.
8, 10
85
Senior clinical staff members make decisions about patient admission
or transfer. They can refuse to accept patients if they fear that the patient mix will compromise safety and/or therapeutic activity.
Guidance: Senior clinical staff members include the service manager or nurse in charge.
10
86
Patients will receive a multidisciplinary pre-admission assessment of need that ensures admissions to the service are appropriate and the
needs of patients are clearly identified. A continuing assessment of need should inform the initial and all future care plans.
Guidance: Methods and tools used for assessment are clinically validated.
Assessments are comprehensive, and include:
Assessment of mental health needs
Problem areas and risk factors Physical health needs
Security risks and needs Safeguarding needs Cultural/spiritual needs (Inc. language and translation needs)
Personal needs Strengths, protective factors and goals
Specialist assessors are used where necessary. Family/friends have been involved where possible.
The purpose and outcome of assessments are explained to patients.
7, 8, 10
No. Standard text and guidance Source
document
19
Treatment and Recovery
87 The multi-disciplinary team (MDT) develops the care plan
collaboratively with the patient and their carer (with patient consent).
10
88
Every patient has a written care plan to reflect their needs, including:
Any agreed treatment for physical and mental health Positive behavioural support plans Advance directives
Specific personal care arrangements Specific safety and security arrangements
Medication management Management of physical health conditions
Guidance: The plan should be developed in collaboration with the patient.
8, 10
89
The multi-disciplinary team (MDT) reviews and updates care plans according to clinical need or at least once a month.
Guidance: The MDT regularly discusses with the patient realistic expectations in relation to length of stay and identifies obstacles or
delays (patient, service or commissioning) to progression.
Patients have the opportunity and support they need to prepare for any formal review of care (ward round/CPA etc.)
There is evidence that patients are encouraged to say whether their formal review of care met their needs.
10
90 The patient and their carer (with patient consent) are offered a copy of the care plan and the opportunity to review this.
10
91
Patients have a pathway of care planned that is realistic and takes account of their aspirations. The plan identifies services the patient is
likely to need through their pathway to the community or to the last realistic point of care.
Guidance: There is evidence of patient participation in care planning.
8
92
Patients have clear personalised outcomes identified in key recovery
areas (if relevant) and understand which outcomes are pathway critical i.e. what they must achieve to progress to the next level of
care. Guidance: Recovery areas may include:
Mental health recovery Insight
Problem behaviours and risk Drugs and alcohol Independent living skills
Physical health There is evidence of patient participation in care planning.
8
93 Clinical outcome measurement data is collected at two time points (admission and discharge) as a minimum, and at clinical reviews
where possible.
10
94 Clinical outcome monitoring includes reviewing patient progress
against patient-defined goals in collaboration with the patient.
10
No. Standard text and guidance Source
document
20
95
Patients are offered evidence based pharmacological and psychological interventions and any exceptions are documented in the case notes.
Guidance: The number, type and frequency of psychological
interventions offered are informed by the evidence base.
10
96
Patients have a personalised plan of therapeutic and skill-developing
activity that is directly correlated to their outcomes plan. Patients can see the connection between activities they are undertaking and the achievement of their recovery goals.
Guidance:
Therapeutic and skill development interventions are evidence based and ‘prescribed’ by need.
o If relevant to outcomes this might include psychology,
occupational therapy, educational, vocational and other skill promoting resources.
There is evidence of a proactive approach to promoting relevant vocational skills/opportunities for patients.
Activities and therapy are planned over seven days and not
limited to conventional working hours. All activities/therapies are planned in a personalised timetable
for each patient.
2, 8
97
Patients have a Care Programme Approach (CPA) meeting within the
first three months and as a minimum every six months thereafter to review ongoing outcomes work and progress.
Guidance: There is evidence that patients are encouraged and supported to play a key participating role in their CPA meeting.
2, 8
98
The team provides information, signposting and encouragement to patients where relevant to access local organisations for peer support
and social engagement such as: • Voluntary organisations • Community centres
• Local religious/cultural groups • Peer support networks
• Recovery colleges
10
Medication
99
When medication is prescribed, specific treatment targets are set for
the patient, the risks and benefits are reviewed, a timescale for response is set and patient consent is recorded.
10
100
Patients have their medications reviewed at least weekly. Medication reviews include an assessment of therapeutic response, safety, side
effects and adherence to medication regime. Guidance: Side effect monitoring tools can be used to support
reviews.
Reviews can take place through multiple formats such as primary nurse assessments, ward rounds etc.
10
101 When patients experience side effects from their medication, this is engaged with and there is a clear care plan in place for managing this.
10
102 The team follows a policy when prescribing PRN (i.e. as required) medication.
10
No. Standard text and guidance Source
document
21
103
Patients prescribed mood stabilisers or antipsychotics are reviewed at the start of treatment (baseline), at 3 months and then annually
unless a physical health abnormality arises. The clinician monitors the following information about the patient:
• A personal/family history (at baseline and annual review) • Lifestyle review (at every review) • Weight (every week for the first 6 weeks)
• Waist circumference (at baseline and annual review) • Blood pressure (at every review)
• Fasting plasma glucose/ HbA1c (glycated haemoglobin) (at every review)
• Lipid profile (at every review)
10
Leave and Discharge
104
The team develops a leave plan jointly with the patient that includes:
• A risk assessment and risk management plan that includes an explanation of what to do if problems arise on leave
• Conditions of the leave
• Contact details of the service
Guidance: The aim and purpose of section 17 leave is clear and clearly relates in context to the strategic plan for care and care pathway
management. If there are concerns about a patient’s cognition, the risk assessment
includes consideration of whether the patient may be driving/using heavy machinery etc., and there is a plan in place to manage this.
10
105
The team supports patients to access organisations which offer: • Housing support
• Support with finances, benefits and debt management Guidance: Housing advice and/or support is given to patients prior to
discharge.
10
106
The service works proactively with the home area care coordinator
and next point of care (including other in-patient services, forensic outreach teams, community mental health teams or prison) to
develop robust discharge/transfer arrangements and minimise delay. Guidance: Patient discharge plans feature triggers and arrangements
for 'recall' to the service/level of care if the patient relapses. When patients are transferred between services/units there is a handover
which ensures that the new team have an up to date care plan and risk assessment.
8, 10
107 Patients and their carer (with patient consent) are invited to a discharge meeting and are involved in decisions about discharge plans.
10
No. Standard text and guidance Source
document
22
108
The service identifies and addresses the immediate needs and concerns of the patient in relation to transitions to other services or to
the community.
Guidance: This is likely to include practical issues such as: Access to money Medication
Clothing Transfer of personal items
Personal care
Forensic Experts
Consensus 2016
No. Standard text and guidance Source
document
23
Clinical Effectiveness – Physical Healthcare
109
All clinical records held by the organisation, including those relating to physical health, are integrated into one patient record.
Forensic Experts
Consensus 2016
110
The team follows a joint working protocol/care pathway with primary health care, specialist, and emergency health teams.
Guidance: This includes the team informing the patient’s GP of any significant changes in the patient’s mental health or medication, or of
their referral to other teams. It also includes teams following shared prescribing protocols with the GP.
There are joint working protocols/care pathways in place to support patients accessing:
• Accident and emergency • Local and specialist mental health services, e.g. eating
disorders, rehabilitation • Primary and secondary physical healthcare • Drug and alcohol services
10
111
Patients have their physical healthcare needs assessed on admission and reviewed every six months or more frequently if required.
Guidance: This should include past medical history and family medical
history, current medication, physical observations, physical examination, blood tests, physical symptoms, lifestyle factors and lifestyle advice.
8, 10
112
Patients are informed of the outcome of their physical health assessment and this is recorded in their notes.
Guidance: With patient consent, this can be shared with their carer.
10
113
Screening programmes are available in line with those available to the general population with the aim of ensuring early diagnosis and
prevention of further ill health. Guidance: The screening programme should recognise the higher
physical health risks for patients in secure mental health, such as diabetes, dyslipidaemia, hypertension, epilepsy, asthma etc.
2
114
The team gives targeted lifestyle advice and provides health promotion activities for patients. This includes:
• Smoking cessation advice • Healthy eating advice • Physical exercise advice and opportunities to exercise
10
No. Standard text and guidance Source
document
24
115
Care plans should consider health outcomes and interventions in the following areas:
Health awareness Weight management
Smoking Diet and nutrition Exercise
Any patient specific items
Guidance: Patients should have specific outcomes identified for understanding and managing long term or chronic illnesses or the management of any medication side effects.
For patients who have not successfully reached their physical health
targets after 3 months of following lifestyle advice, the team discusses further intervention.
8, 10
116
The team understands and follows an agreed protocol for the management of an acute physical health emergency.
Guidance: This includes guidance about when to call 999 and when to contact the duty doctor.
10
117 Emergency medical resuscitation equipment (crash bag) is available within three minutes.
10
118 The crash bag is maintained and checked weekly, and after each use. 10
No. Standard text and guidance Source
document
25
Clinical Effectiveness – Workforce
119
There is a cohesive multi-disciplinary team in place who have the capacity and capability required to meet the complex needs of
patients.
Guidance: The team includes psychiatrists, nurses (including primary care), healthcare assistants, psychologists, occupational therapists, social workers and educational professionals.
2, 7
120
The service has access to interpreters and the patient’s relatives are not used in this role unless there are exceptional circumstances.
Guidance: Exceptional circumstances might include crisis situations
where it is not possible to get an interpreter at short notice.
10
121
The service has a mechanism for responding to low staffing levels,
including: • A method for the team to report concerns about staffing levels • Access to additional staff members
• An agreed contingency plan, such as the minor and temporary reduction of non-essential services
10
122 The service is staffed by permanent staff members, and temporary bank and agency staff are used only in exceptional circumstances,
e.g. in response to additional clinical needs.
10
123
If the service uses bank and agency staff members, the service
manager monitors their use on a monthly basis. An overdependence on bank and agency staff members results in action being taken.
10
124
There has been a review of the staff members and skill mix of the team within the past 12 months. This is to identify any gaps in the team and to develop a balanced workforce which meets the needs of
the service.
10
125
New staff members, including bank and agency staff, receive an
induction based on an agreed list of core competencies.
Guidance: This should include arrangements for shadowing colleagues on the team; jointly working with a more experienced colleague; being observed and receiving enhanced supervision until core
competencies have been assessed as met.
10
126
Staff members and patients feel confident to contribute to and safely
challenge decisions.
Guidance: This includes decisions about care, treatment and how the service operates.
10
127
Staff members feel able to raise any concerns they may have about standards of care.
Guidance: There is an active system in place for whistleblowing and raising concerns regarding standards of care.
10
128 All staff who hold keys and/or have contact with patients have a valid enhanced DBS check.
2, 7
No. Standard text and guidance Source
document
26
Supervision and Support
129
All staff members receive an annual appraisal and personal
development planning (or equivalent). Guidance: This contains clear objectives and identifies development
needs.
10
130
All clinical staff members receive clinical supervision at least monthly,
or as otherwise specified by their professional body.
Guidance: Supervision should be profession-specific as per professional guidelines and provided by someone with appropriate clinical experience and qualifications.
10
131 Staff members in training and newly qualified staff members receive weekly supervision.
10
132 All staff members receive monthly line management supervision. 10
133
All staff members have access to reflective practice. Guidance: There is a comprehensive approach to reflective practice,
which includes: Personal reflection
Group reflection Formal reflective practice sessions
10
134
The service actively supports staff health and well-being. Guidance: For example, providing access to support services,
monitoring staff sickness and burnout, assessing and improving morale, monitoring turnover, reviewing feedback from exit reports
and taking action where needed.
10
Training
135
Clinical staff members have received formal training to perform as a
competent practitioner, or, if still in training, are practising under the supervision of a senior qualified clinician.
10
136
Staff members receive training consistent with their role, which is recorded in their personal development plan and is refreshed in
accordance with local guidelines. This training includes: • Statutory and mandatory training • The use of legal frameworks, such as the Mental Health Act (or
equivalent) and the Mental Capacity Act (or equivalent) • Physical health assessment
Drug and illicit substance awareness • Immediate Life Support • Recognising and communicating with patients with special
needs, e.g. cognitive impairment or learning disabilities • Recovery and outcomes approaches
A patient’s perspective • Carer awareness, family inclusive practice and social systems,
including carers' rights in relation to confidentiality
Guidance: Physical health could include training in understanding
physical health problems, physical observations and when to refer the patient for specialist input.
8, 10
No. Standard text and guidance Source
document
27
137
The teams receive training, consistent with their roles, on risk assessment and risk management. This is refreshed in accordance
with local guidelines.
This includes, but is not limited to, training on: • Safeguarding vulnerable adults and children • Assessing and managing suicide risk and self-harm
• Prevention and management of aggression and violence
10
138
The team effectively manages violence and aggression in the service.
Guidance:
Staff members do not deliberately restrain patients in a way that affects their airway, breathing or circulation
Restrictive intervention always represents the least restrictive
option to meet the immediate need Individualised support plans, incorporating behaviour support
plans and advanced directives, are implemented for all patients who are known to be at risk of being exposed to restrictive interventions
The team does not use seclusion or segregation other than for patients detained under the Mental Health Act (or equivalent)
The team works to reduce the amount of restrictive practice used
Providers report on the use of restrictive interventions to
service commissioners, who monitor and act in the event of concerns
10
139 All staff members who administer medications have been assessed as competent to do so. Assessment is repeated on a yearly basis using a
competency-based tool.
10
140 There are systems in place to assess staff knowledge of policies
critical to their role.
8
141 Patients and carers are involved in delivering face-to-face training. 10
No. Standard text and guidance Source
document
28
Governance
142
Findings from investigations, measures and reports are routinely shared between the team and the board, and vice versa, so that
lessons can be learnt.
Guidance: For example, findings from serious incident investigations, reports on length of stay, service level activity and examples of innovative practice. Findings should be disseminated in an accessible
format.
8
143
The service has in place a clear strategy of how it engages with all
external stakeholders for the benefit of patients and the service.
Guidance: Stakeholders include patients and their family and friends, staff at all levels of the organisation, referring parties and services involved in supporting effective discharge.
8
144
The service’s policy and procedures are developed and implemented in consultation with the whole service.
Guidance: The process for developing and implementing policies and
procedures is fully inclusive and involves all affected stakeholders as a minimum. Patients, family and friends and staff members are involved in key decisions about the service provided through consultation.
7, 10
145 There is a process in place to enable patients and their representatives to view policies critical to their care.
8
146
All patient information is kept in accordance with current legislation.
Guidance: Staff members ensure that no confidential data is visible beyond the team by locking cabinets and offices, using swipe cards
and having password protected computer access and ensuring computer screens are not visible through reflection or direct sight.
10
147 The patient’s consent to the sharing of clinical information outside the clinical team is recorded. If this is not obtained the reasons for this are recorded.
10
148 There is a widely accessible complaints procedure that clearly sets out the ways in which a complaint can be made, the process for
investigation and how communication is managed throughout.
2, 8
149
Staff, patients, their families and friends (where the patient consents)
are involved in the complaints process from start to finish and are regularly updated on the progress of investigation and outcomes of
the complaint.
2, 8
150 Complaints are reviewed at a minimum quarterly to identify themes, trends and learning.
2, 8
151
The contingency plan addresses: • the chain of operational control
• communications • patient and staff safety and security
• maintaining continuity in treatment and • accommodation
and is tested by live and desktop exercises.
2, 4, 7, 8
152 Systems are in place to enable staff members to quickly and effectively report incidents and managers encourage staff members to
do this.
10
No. Standard text and guidance Source
document
29
153 A collective response to alarm calls is rehearsed at least 6 monthly. 10
154 Staff members share information about any serious untoward incidents involving a patient with the patient and their carer (with patient consent), in line with the Statutory Duty of Candour.
10, 11
155 Staff members, patients and carers who are affected by a serious or distressing incident are offered post incident support.
10
156
The safe use of high risk medication is audited and reviewed, at least annually and at a service level.
Guidance: This includes medications such as lithium, high dose
antipsychotic drugs, antipsychotics in combination, benzodiazepines.
10
157
The team audits the use of restrictive practice, including face-down
restraint. Guidance: Staff members know how often patients are restrained and
how this compares to benchmarks, e.g. by participating in multi-centre audits or by referring to their previous years’ data.
10
158
An audit of environmental risk is conducted annually and a risk management strategy is agreed.
Guidance: This includes an audit of ligature points.
10
159
Outcome data is used as part of service management and development, staff supervision and caseload feedback.
Guidance: This should be undertaken every six months as a minimum.
10
160 A range of local and multi-centre clinical audits is conducted which
include the use of evidence based treatments, as a minimum.
10
161 The team, patients and carers are involved in identifying priority audit
topics in line with national and local priorities and patient feedback.
10
162
When staff members undertake audits they:
Agree and implement action plans in response to audit reports Disseminate information (audit findings, action plan) Complete the audit cycle
Guidance: audits may include topics such as use of control and
restraint or restrictive practice.
10
30
References
1 Department of Health (2002). Mental Health Policy Implementation Guide: National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments.
http://napicu.org.uk/wp-content/uploads/2013/04/2002-NMS.pdf
2 Department of Health (2006). Standards for better Health. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4132991.pdf
3 Department of Health (2011). Environmental Design Guide: Adult Medium Secure
Services. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215623/dh_126177.pdf
4 Department of Health (2012). Low Secure Services: Good Practice Commissioning Guide,
Consultation Draft. http://apps.bps.org.uk/_publicationfiles/consultation-responses/Low%20Secure%20Services%20&%20Psych%20Intensive%20Care%20-
%20cons%20paper%201.pdf
5 Department of Health (2015). Mental Health Act 1983: Code of Practice. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/
MHA_Code_of_Practice.PDF 6 NAPICU (2014). National Minimum Standards for Psychiatric Intensive Care in General
Adult Services. http://napicu.org.uk/wp-content/uploads/2014/12/NMS-2014-final.pdf
7 QNFMHS (2012). Standards for Low Secure Services.
http://www.rcpsych.ac.uk/pdf/QNFMHSStandardsLowSecureServices.pdf
8 QNFMHS (2014). Standards for Medium Secure Services.
http://www.rcpsych.ac.uk/pdf/QNFMHS%20Standards%20for%20Medium%20Secure%20Services%20%202014%20Amended.pdf
9 QNFMHS (2015). See, Think Act: Your Guide to Relational Security. 2nd Edition. http://www.rcpsych.ac.uk/pdf/STA_hndbk_2ndEd_Web_2.pdf
10 Royal College of Psychiatrists (2015). Standards for Inpatient Mental Health Services.
http://www.rcpsych.ac.uk/pdf/RCPsych_Standards_In_2016.pdf
11 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
http://www.legislation.gov.uk/ukdsi/2014/9780111117613/pdfs/ukdsi_9780111117613_en.pdf
31
Appendix 1: Development of Core Standards for Inpatient Services
The following text was taken from the introductory section of the Royal College of
Psychiatrists Standards for Inpatient Mental Health Services, 201510.
Description and scope of the standards The core standards for inpatient mental health services have been developed by the Royal College of Psychiatrists’ College Centre for Quality Improvement (CCQI) and the
British Standards Institution (BSI).
The inpatient standards cover access to the ward/unit and what a good admission looks like (which includes assessment, care, treatment and discharge planning). They also cover ward/unit environment, staffing and governance.
Within the core standards some minimum standards have been included. This is to
ensure that wards/units/services which are members of quality improvement programmes hosted by the CCQI are safe, comply with the law, respect patients’ rights and provide the fundamentals of care.
How the standards were developed
The CCQI and BSI undertook a review of 17 sets of its existing standards to identify which standards were ‘core’ to all mental health services. These core standards then underwent an extensive review process. A steering group and a reference group made
up of clinical, patient and family and friends experts enabled representation from each of the different specialties whose standards were used in this project. Feedback was
also sought from other sources including CCQI staff, the chair persons of the different CCQI advisory groups and representatives from the College’s faculties and divisions.
The following principles were used to guide the development of these standards:
Access: Patients have access to the care and treatment that they need, when and where they need it.
• Compassion: All services are committed to the compassionate care of patients,
carers and staff.
• Valuing relationships: The value of relationships between people is of primary
importance. • Patient and carer involvement: Patients and carers are involved in all aspects of
care.
Learning environment: The environment fosters a continuous learning culture. Leadership, management, effective and efficient care: Services are well led and
effectively managed and resourced.
• Safety: Services are safe for patients, carers and staff.
32
Appendix 2: Acknowledgements
The Quality Network for Forensic Mental Health Services would like to extend our thanks to all of those who have supported the development of these standards, in particular:
• Members of the Advisory Group, in particular Quazi Haque, Vicky Hitch and Jude
Deacon (Appendix 4)
• Delegates of the Optimising Secure Patient Pathways event, March 2016
• Delegates of the standards consultation event, March 2016 (appendix 2)
• Those who provided response via the electronic consultation
• QNFMHS Patient Reviewers and Family and Friends Representatives
• QNFMHS Project Team
33
Appendix 3: Standard Consultation Attendees
Name Job title Organisation
Elizabeth Allen Independent Consultant FrontFoot
Luke Birmingham Consultant Forensic Psychiatrist (Adult Forensic Service)
Southern Health NHS Foundation Trust
Margaret Britton Family and Friends Representative Quality Network for Forensic Mental Health Services
Sheryle Cleave Senior Clinical Nurse (Adult Specialist Group)
Northumberland, Tyne and Wear NHS Foundation Trust
George Cooley Family and Friends Representative Quality Network for Forensic Mental Health Services
John Croft Consultant Forensic Psychiatrist Birmingham and Solihull Mental Health NHS Foundation Trust
Jude Deacon Head of Forensic Mental Health and Prison Healthcare Services
Oxford Health NHS Foundation Trust
Sian Dolling Clinical Service Manager Abertawe Bro Morgannwg University Health Board
Mark Fassihi Staff Nurse Norfolk and Suffolk NHS Foundation Trust
Rick Fuller General Manager Nottinghamshire Healthcare NHS Foundation Trust
Quazi Haque Consultant Forensic Psychiatrist, Group Medical Director and Chair
of the QNFMHS Advisory Group
Partnerships in Care
Vicky Hitch Lead Occupational Therapist St Andrew’s Healthcare
Michael Humes Patient Reviewer Quality Network for Forensic Mental Health Services
Dawn Jeffries Interim Regional Hospital Director Priory Group
Stephen Keeley Ward Manager Dorset Healthcare University
NHS Foundation Trust
Nick McAndrew Staff Nurse Abertawe Bro Morgannwg
University Health Board
Zena Nassa Consultant Psychiatrist Kent and Medway NHS
Partnership Trust
Patrick Neville Strategic Development Director Partnerships in Care
Fungai Nhiwatiwa Hospital Director Partnerships in Care
Seb Pringle Patient Reviewer Quality Network for Forensic Mental Health Services
Amanda Santaney Clinical Governance/Workforce Development Manager
Nottinghamshire Healthcare NHS Foundation Trust
Mark Scott Ward Manager Northumberland Tyne and
Wear NHS Foundation Trust
Steven Woolgar Director of Policy and Regulation Partnerships in Care
34
Appendix 4: Advisory Group
First Name Role Organisation
Zeba Arif Chair of Forensic Nursing Forum Royal College of Nursing
Margaret Britton Family and Friends Representative
Quality Network for Forensic Mental Health Services
Nikki Churchley Mental Health and Programme of Care Lead
South of England South West Team, NHS England
Sheryle Cleave Senior Clinical Nurse Northumberland Tyne and Wear NHS Foundation Trust
George Cooley Family and Friends Representative
Quality Network for Forensic Mental Health Services
Louise Davies Mental Health and Programme of Care Lead
Yorkshire and Humber Team, NHS England
Jude Deacon Head of Forensic Mental Health and Prison Mental Health
Services
Oxford Health NHS Foundation Trust
Richard Eccles Programme of Care Senior Manager
NHS England
Tom Fahy Consultant Psychiatrist and Chair of Forensic Faculty
Royal College of Psychiatrists
Quazi Haque
Consultant Forensic Psychiatrist, Group Medical Director and
Chair of the QNFMHS Advisory Group
Partnerships in Care
Kerry Hinsby Lead Consultant Clinical and Forensic Psychologist
Leeds and York Partnership NHS Foundation Trust
Victoria Hitch Lead Occupational Therapist St Andrew’s Healthcare
Michael Humes Patient Reviewer Quality Network for Forensic Mental Health Services
Dawn Jeffries Director of Clinical Services Priory Group
Harry Kennedy Executive Clinical Director and Consultant Forensic Psychiatrist
National Forensic Mental Health Service
Jeremy Kenney-Herbert
Clinical Director/Consultant Forensic Psychiatrist
Birmingham and Solihull Mental Health NHS Foundation Trust
Mat Kinton Mental Health Act Policy Advisor Care Quality Commission
Seb Pringle Patient Reviewer Quality Network for Forensic
Mental Health Services
Mike Wheeler
Forensic Outreach Service and
Forensic Social Work Team Manager
National Group for Social Work Managers in Secure Services
35
Appendix 5: QNFMHS Project Team, Patient Reviewers and Family and Friends Representatives (correct at time of standards revision,
May 2016)
QNFMHS Project Team Renata Souza, Programme Manager Sam Holder, Deputy Programme Manager
Sandra Adisa, Project Worker Daniella Dzikunoo, Project Worker
Madhuri Pankhania, Project Worker Joanna Parketny, Project Worker Karen Traynor, Project Worker
Patient Reviewers
Kristie Byrne Ian Callaghan Rebecca Condron
Susan Denison Suzanne Harrison
Michael Humes Hannah Moore Godwin Uto Nkere
Seb Pringle James Saunders
Roger Sharp Helen Slater
Family and Friends Representatives Margaret Britton
Maureen Clare George Cooley Clari East
36
Appendix 6: Glossary and Abbreviations
Abbreviation or Term Definition
Advance directive A document drawn up by a person when they are well, saying how they want to be cared for if they
become unwell.
Advocacy services
A professional service which seeks to ensure that
patients are able to speak out, to express their views and defend their rights.
AMPs Approved Mental Health Professionals
Antipsychotics medication Used to treat psychotic illness.
Bank and agency staff Non-permanent staff members.
Bed occupancy levels Proportion of beds within an organisation which are occupied by patients.
BSI British Standards Institute
Capacity The ability to understand and weigh up information, make a decision and communicate that decision.
Care plan
An agreement between an individual and their
health professional (and/or social services) to help them manage their health day-to-day. It can be a written document.
Care Programme Approach Also none as the CPA. A way of coordinating care for people with mental health problems and/or a range
of different needs.
Carer Anyone who has a close relationship with the patient or who cares for them.
CCQI College Centre for Quality Improvement
CCTV Closed-Circuit Television
Clinical formulation
A theoretically based explanation of a patient's
presentation. It covers the presenting problem and predisposing, precipitating, perpetuating and protective factors.
Clinical supervision
A regular meeting between a staff member and their clinical supervisor. A clinical supervisor's key duties
are to monitor employees' work with patients and to maintain ethical and professional standards in
clinical practice.
Commissioners
Individuals (or groups of individuals) whose role it is
to purchase health and other services for their local patient population (such as NHS England).
Community meeting A meeting of patients and staff members which is held on the ward.
37
Consent A patient gives their permission for something to happen.
Control and restraint
Control and restraint is the systematic use of
approved physical techniques aimed at restraining or breaking away from an individual who is likely to,
or is acting in, a manner likely to result in harm to themselves or others.
CPD Continued Professional Development
CPN Community Psychiatric Nurse
CQC Care Quality Commission
CRGs Clinical Reference Groups
Crisis and contingency plan
A document drawn up by a person when they are well, with their key worker. It includes relapse
warning signs, what they can do to manage the situation themselves, who to contact and when, and
what has been helpful and unhelpful in the past.
DH Department of Health
Dual diagnosis Experiencing both severe mental illness and problematic drug and/or alcohol use.
Duty of Candour
This is a legal responsibility and requirement on a
hospital, community and. mental health trusts to inform and apologise to patients if there have been
mistakes in their care that have led to significant harm.
Fasting plasma glucose/ HBA1c Blood tests which measure glucose levels.
GP General practitioner or ‘family doctor’.
Group dynamics The way in which people in a group interact with one another.
Home Treatment/Crisis
Resolution Team
Some teams call themselves ‘crisis resolution’,
others call themselves ‘home treatment’, and some are both. These teams all treat people with severe mental health problems in their own homes or in
suitable residential facilities.
Hyperlipidaemia High levels of cholesterol or triglycerides.
Key worker/ primary nurse/ named nurse
A named individual who is designated as the main
point of contact and support for a patient who has a need for ongoing care.
Ligature points Structures or fittings which could be used in suicide
by hanging or strangulation.
38
Line management supervision
Supervision involving issues relating to the job description or the workplace. A managerial supervisor’s key duties are; prioritising workloads,
monitoring work and work performance, sharing information relevant to work, clarifying task
boundaries and identifying training and development needs.
Lipid profile A blood test used to measure cholesterol and triglyceride levels.
LSU Low Secure Unit.
MAPPA Multi-Agency Public Protection Arrangements
Mental Capacity Act
A law which is designed to protect and empower
individuals who may lack the mental capacity to make their own decisions about their care and
treatment.
Mental Health Act
A law under which people can be admitted or kept in
hospital, or treated against their wishes, if this is in their best interests or for the safety of themselves or others.
Mood stabilisers
Medication used to treat mood disorders.
MSU Medium Secure Unit
Multidisciplinary team
A team made up of different types of health
professionals, also referred to as the MDT.
NHS National Health Service
NICE
National Institute for Health and Care Excellence. Publishes guidance for health services.
Observation
A therapeutic nursing intervention which aims to
reduce the factors which contribute to an individual patient’s risk (to themselves and/or others) and to
promote recovery. There are different levels of observation such as general (minimum acceptable
level for all inpatients) and continuous (one-to-one nursing).
Organisation’s board A board of directors is a body of appointed members who jointly oversee the activities of an organisation.
OT Occupational Therapy
PDP Personal Development Plans
Peer support The help and support that people with a shared lived
experience can give to one another.
Positive risk taking
Allowing people to take responsibility for their actions, to empower them and to improve understanding of decision making and
consequences.
39
PSD Physical Security Document
PSID Procedural Security Index Document
Psycho-education group A group in which patients come together to learn
about mental illness and how to live with it.
QIPP Quality Innovation Productivity Prevention
QNFMHS Quality Network for Forensic Mental Health Services
Rapid tranquilisation
The use of medication to calm/lightly sedate the
patient, reduce the risk to self and/or others and achieve an optimal reduction in agitation and aggression.
RCPSYCH Royal College of Psychiatrists
Recovery College
A service that gives people with mental health problems the opportunity to access education and
training programmes designed to help them in their recovery.
Reflective practice The ability for people to be able to reflect on their
own actions and the actions of others.
Restrictive intervention
Deliberate acts on the part of other person(s) that restrict a patient’s movement, liberty and/or freedom to act independently in order to:
1) take control of a dangerous situation where there is a real possibility of harm to the person or others if
no action is taken, and 2) end or reduce significantly the danger to the patient or others.
Seclusion
Supervised confinement and isolation of a patient away from other patients in an area which the
patient is prevented from leaving, where it is of immediate necessity for the purpose of containment
of severe behavioural disturbance which is likely to cause harm to others.
Segregation A situation where in order to reduce a sustained risk of harm posed by the patient to others, a patient is not allowed to mix with other patients on the ward.
STA See Think Act – your guide to relational security.
Statutory carers’ assessment An assessment of a carer's needs by an appropriate statutory organisation (Carer in this context refers
to anyone in a caring role).
Therapeutic environment
A place which attends to psychological, emotional
and social factors in creating a space that maximises the potential for healing, development and growth.
Ward/Unit/Service Place in which the care and treatment of the patient
takes place.
2016
Royal College of Psychiatrists’ Centre for Quality Improvement
21 Prescot Street London E1 8BB
The Royal College of Psychiatrists is a charity registered in England and Wales
(228636) and in Scotland (SC038369)
© 2016 The Royal College of Psychiatrists
www.rcpsych.ac.uk
