At Care in Mind, we work within a least restrictive model, with an emphasis on therapeutic risk management.
The dilemma of risking or restricting risk comes down weighing up long-term benefits with present day risks. So, why do we believe in long-term benefits and managing risk therapeutically and with the least restraint?
When a young person spends lots of time in a hospital, it can lead to a heavy reliance on others to protect them. Additionally, it can be easy for them to unlearn, or become fearful of, various normal areas of life, such as making a cup of tea or using metal cutlery. Essentially, it can significantly hinder their ability to learn the value in responsibility and independence. This is especially true of young people who may have been in and out of hospital during their early teenage years.
As well as a loss of independence and reliance on others, heavy restrictions can cause young people to feel out of control. Losing this control may lead them to take increased risks as time goes on, thus they find themselves in a dangerous cycle of risky behaviour.
Of course, it is understandable that restrictive care has become the norm, as what is a natural reaction to someone hurting themselves? It is to take away that risk and stop them. However, at Care in Mind, we have intensive training in place for our residential staff so that this reaction can be challenged. Instead of restrictive care, we focus on assertive care and train our staff to support young people in keeping themselves safe. Our least restrictive model is very much based on the principles of Therapeutic Risk Management.
The Principles Of Therapeutic Risk Management
There are five principles of Therapeutic Risk Management and they each underlie our Therapeutic Risk model, which is paramount to successful risk management in a least restrictive manner.
The first principle is focused on collaboration, therapeutic rcaelationships and informed decision making on the young person’s part. Care in Mind young people are put at the forefront of their own care and work alongside our comprehensive MDT to ensure they receive care that is most helpful for them. Much of those relies on an open and honest relationship between staff and young people, which gives them the confidence to trust those who care for them.
The second principle is about creating a strength based, person-centred approach to recovery. This is done utilising the “Managing Mental Health Ladder” and the “Mental Health Recovery Star” (Recovery Star™ (4th Edition) – Triangle (outcomesstar.org.uk). The ladder is all about progressing how you manage your mental health issues. To assess how young people progress and to ensure we focus on the necessary areas of recovery, we utilise the “Mental Health Recovery Star”. These will be filled out on a regular basis throughout the young person’s time within the homes to document how they are doing.
The third principle is about effective team-working and building risk-sharing partnerships. This is about the way we always care for young people being understood and consistent, including when liaising with Emergency Services, Social Care and Safeguarding teams. Maintaining a stable level of least restrictive care is vital in minimising the risk of further setbacks into a risky cycle of behaviour.
The fourth principle is providing a safe culture for both residential staff and the young people. A significant part of this is through reflective practice and a no blame culture. We try to take every opportunity to learn from where we may have gone wrong and improve upon our practice, both individually and as an organisation. Rather than having one way of doing things and strictly enforcing that, we encourage staff to bring forward any innovative ideas they may have.
The fifth and final principle is about providing least restrictive interventions. Rather than removing risks, using physical restraint, or conducting observations on people, we utilise less invasive ways to care for our young people.
Naturally, a least restrictive environment is not suited to every individual and their mental health journey. In cases where young people are actively suicidal, have a means to end their own life or lack capacity, we may not necessarily recommend a least restrictive model of care. It all comes down to assessing potential risks and weighing up the potential benefits for each unique individual.
For some young people, a least restrictive environment and therapeutically managed risks can allow them to gain the necessary independence to thrive once they leave residential care. It can help break the cycle of readmission and give them the self-belief that they can take responsibility for their own safety.
Therefore, we choose to risk (where appropriate), because it can help the young person learn to live their most safe, satisfying, and meaningful life.