DkIT major international players in reducing the use of restrictive practices
Dundalk Institute of Technology are national leaders when it comes to research and designing policy to reduce the use of restrictive practices.
Restrictive practices are defined as devices, mechanisms, protocols or procedures that limit the liberty of the individual, often in clinical settings. “This can be anything, from a dementia patient being locked in a room to someone being strapped to a bed,” says Dr Kevin McKenna.
Dr McKenna is a nurse, psychologist and a lecturer in the school of Health and Science in DkIT. He has completed a PhD on restrictive practices. He recently was a keynote speaker at the Restraint Reduction Network’s annual conference in Birmingham. The Network’s main goal is to limit the use of restrictive practices.
Dr McKenna explains that restrictive practices can take place in the home, or in the health and education system. “Surprisingly, the mental health system is actually quite well-regulated,” Dr McKenna reveals. “The Mental Health Commission has a register, where all practices used on a patient are recorded and detailed, and the length of time that a restrictive practice is used is recorded,” he explains.
Dr McKenna says that sadly, within the education system, the use of restrictive practices can still occur. Isolation can often be used for discipline. “Some schools have rooms called quiet or soft rooms, but there is no way of telling what the condition of these rooms are actually like,” Dr McKenna says. “At the conference, it was revealed that one third of schools and adolescent services in the UK could not say the number of times restrictive practices had been used,” Dr McKenna says. Children who are very young can be subjected to restrictive practices, usually by way of segregation. “Think of naughty steps or bold corners,” says Dr McKenna.
“So, what we see is restrictive practices are being used early in life, right up until the end,” says Dr McKenna. Elderly people in care homes, many of whom suffer from dementia, can be the victim of restrictive practices. “This can be something as simple as a locked door,” says the lecturer.
There have been many high-profile cases of restrictive practices and abuse, especially involving people who have intellectual disabilities. “Just think of Aras Attracta in Sligo, and England’s Winterbourne… these cases were only recent. The use of these practices is still wide-spread,” says Dr McKenna.
What is most shocking about the use of restrictive practices is the fact that there is no scientific evidence to prove that they work. “Restrictive practices have no evidence-based results… what is even more worrying is that there is little international agreement on what constitutes as good practice,” Dr McKenna says.
“There are no randomised control trials, no empirical data supporting their use… there was a study carried out across 16 European countries where four clinical scenarios were presented. What some countries thought was best practice was considered unlawful in others. There is no consistency,” Dr McKenna reveals.
The use of restrictive practices also negatively impacts the carer as well as the person on the receiving end. “Gwen Bonner carried out a study called ‘Trauma for All’, and what she found was that the use of restrictive practices was distressing for everyone involved, even if they were employed as a safety measure,” reveals Dr McKenna.
DkIT is recognised as a national leader when it comes to conducting academic research on the use of restrictive practices. “The British Institute of Learning Disabilities recognises our research, which is quite a privilege,” says Dr McKenna. “We have carried out studies on regressional violence in social care, and we have created the Seclusion and Restraint Reduction Strategy in conjunction with the Mental Health Commission,” says Dr McKenna. “DkIT also had the first degree in the world which studies aggression and violence in social care,” he reveals. “Now 17 or 18 countries offer similar programmes.”
“DkIT with the North Eastern Health Board carried out a lot of research in the early 2000’s… there really was, and still is, no other college in the country with an interest in this. We are research leaders in that regard, not to toot our own horns… we have presented our findings to the World Health Organisation in Geneva, and national strategies have been written in Dundalk.” DkIT therefore is a national leader and global contributor in reducing restrictive practices.
Dr McKenna is hopeful that the use of restrictive practices on vulnerable people will be reduced. “We have seen an improvement since we first started our work back in 2001, but perhaps we are frustrated with the speed of implementation,” admits Dr McKenna. “There is a higher visibility and lower tolerance for restrictive practices, and we hope that our policies will be implemented across the board one day.”