Creating a culture of safety in inpatient settings: the development and scale up of a national quality improvement programme to reduce restrictive practice across England

Helen Smith, Brendan Stone, Kate Lorrimer, Kay Khan, Tom Ayers

75 minutes


July 2023

Congress webinar 2023


This session will involve a panel discussion to share the work of the Mental Health Safety Improvement Programme (MHSIP) to reduce restrictive practice over the course of the last 4 years. The work began in October 2018 with the development of a co-designed pilot quality improvement collaborative which was delivered by the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists. This pilot work led to the development of a holistic end-of-programme theory of change, which was then packaged for scale up and spread across the country. The scale up now involves over 200 wards across 47 NHS MHLDA Trusts and 5 private providers of NHS-funded inpatient services. This number includes wards across all specialisms of MHLDA care.

For a long time, we have had a systemic and moral imperative to act to reduce restrictive practice, but we now also have a legislative one through the introduction of Seni’s Law - The Mental Health Units (Use of Force) Act 2018. We have also been recently reminded of the desperate need for widespread action, by the media attention surrounding the toxic cultures within some mental health services. The work of the MHSIP aims to address these complex challenges.

This session will give you an understanding of:

- Restrictive practice as harmful. It often contravenes a patient’s human rights and can be traumatic and/or retraumatising – it causes iatrogenic harm; it can also be distressing for staff and high levels of restrictive practice on a ward have an impact on levels of stress, feelings of safety and morale

- The importance of coproduction.

- A human rights-based and trauma-informed approach to care.

- Inequalities.

- The challenges of large-scale national scale up and spread of a quality improvement programme.

- The need to create a national movement (utilisation of system levers, awareness raising, etc).

- The programme of work as a complex culture-based intervention, not just a change package/bundle in the traditional sense.

- The wider benefits to patient and staff well-being.


Chair: Helen Smith, NHS England, London, United Kingdom

Brendan Stone, NHS England, London, United Kingdom

Kate Lorrimer, NHS England, London, United Kingdom

Kay Khan, NHS England, London, United Kingdom

Tom Ayers, Royal College of Psychiatrists, London, United Kingdom


Log in to see options tailored to you