The impact of the panorama documentary 'Undercover care the abuse exposed'
Inspection of Services
On a final note what can we say about the regulation of services? Inspection should be an 'unannounced' process. It is difficult to always reveal abusive practices, but our system needs to be more robust. There needs to be a very transparent whistle blowing process to inspection services.
- Better quality environments for people who challenge let us stop clustering distressed people together. It is my view that commissioning services on an individualised support basis represents the best way forward.
- Make these environments enriching and fun. (I have a simple rule it is quite easy to witness service users laugh or show signs of happiness, this does not require fancy measurement!).
- We need to understand that many challenging behaviours are linked to the stress of individuals and the lack of purpose in their lives.
- We need to make staff more reflective about their own contribution to challenging behaviours, (this is the cornerstone of the low arousal approach) (McDonnell, 2010). If a person recognises that they are part of the problem then they can become part of the solution.
- Training in behaviour management needs to challenge the attitudes and beliefs of staff. Training should contain clear messages of what is unacceptable practice.
- Training organisations need to accept that they have a role in investigating the implementation of their training in the area of physical interventions. We believe that training organisations need to provide evidence that they have audited their training post delivery.
- There needs to be clear organisational messages about what is acceptable and unacceptable practice. Organisation need to publicly pledge to minimise the use of restraint and other restrictive practices and make data available to public scrutiny.
- All physical interventions usage should be considered as a failure of communication. If we are to eradicate such approaches we need restrict their use in training and in the workplace. I call for organisations to consider that every individual who attracts physical interventions on a monthly basis should have a clear restraint reduction plan.
- I would call upon organisations themselves to ban the use of specific physical interventions. These organisations should not wait for a governmental decree. I was involved with the Millfields charter which called for a ban on prone restraint (McDonnell, 2007). We at Studio3 would go much further and call for a ban on supine restraint as well.
- With regard to inspection, I would support increases in unannounced visits to services but, in my opinion this will not help reduce abuse. I believe that Inspection does require a covert investigation arm. I feel strongly that agencies themselves need to be publicly more proactive about reducing the use of restrictive practices and creating a culture of zero tolerance to abusive practice.
A positive note
I would like to end this on a positive note. I cannot claim to have truly invented the concept of a low arousal approach. In the past there have been many great innovators in this field. In my book 'Managing aggressive behaviour in care settings: Understanding and applying low arousal approaches' I illustrated this point by examining the work of the physician Jean Marc Gaspard Itard. In 1799 the so called 'wild boy' was discovered in Aveyron in Southern France. Victor was mute and attempts were made by to restore his speech and socialise the young man. Although Itard could not help him to speak Victor was reported to be more placid and capable of understanding some verbal communication and showing empathy. Victor lived with Itard and his housekeeper Madame Guérin until his death in Paris in 1828. The approach adopted to manage Victor contained strong elements of low arousal approaches. I would finish with Itard's observations about how to work with Victor He was acquainted with four circumstances only; to sleep, to eat, to do nothing, and to run about in the fields. To make him happy, then, after his own manner, it was necessary to put him to bed at the close of the day, to furnish him abundantly with food adapted to his taste, to bear with his indolence, and to accompany him in his walks, or rather in his races in the open air, and this whenever he pleased.' (p38).