Making PROGRESS to improve mental health care

New results show that a scheme to reduce physical restraint and force in mental health inpatient settings has improved care and patient experiences.

PROMISE (PROactive Management of Integrated Services and Environments) developed at Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), is designed to change culture and reduce physical interventions in mental health settings, which can be extremely distressing to patients and staff. PROMISE is supported by five actions – PROGRESS (Report, Reflect, Review, Rethink and Refresh) developed by frontline staff and patients to help make decisions based on individual care needs.

The team reports in the BMJ Open Quality Journal that over a three-year period, CPFT saw a remarkable drop (58%) in incidents of face down restrains and all forms of physical interventions, as well as high patient experience scores.

Dr Manaan Kar Ray, co-founder of PROMISE and consultant psychiatrist said:  “These improvements in care would not have happened without the efforts of frontline staff and people with mental health challenges who co-produced the initiatives. The national award that PROMISE won for patient experience in 2016 celebrates this combined approach. Thank you to everyone who has supported the scheme.”

Co-founder of PROMISE and CPFT expert-by-experience Sarah Rae said: “It’s great to see such positive results from our NHS frontline services using this proactive care approach to improve the patient experience and reduce distress. Frontline innovation and active involvement of patients – who co-designed the initiatives, have helped to prevent situations escalating. The study demonstrates how changing care delivery and culture creates a better experience for patients and staff.”

The PROMISE project has been funded and supported by the Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC EOE), hosted by CPFT.

Professor Peter Jones, Non-Executive Director at CPFT and Director of CLAHRC EOE said: “PROMISE provides a blueprint for delivering high quality mental health care with compassion and dignity for patients. This study shows how proactive care can be used to prevent use of physical restraint and support recovery for people using our services. I hope the results of the study will encourage other organisations to adopt the approach.”

Some observations from the study have been published in peer reviewed journals, but this July update shares all the data and figures from 2014 to 2017, giving physical intervention numbers and drawing on over 4,500 patient experience surveys.

Across the Trust:

  • Face down restrains fell by 58%
  • Overall physical intervention numbers fell by 35%, after assessing the care needs of individual patients.
  • Patient satisfaction with care was measured at 87%
  • 98% of patients reported that staff were polite and friendly
  • 97% found staff to be welcoming at admission
  • 96% felt their respect and dignity was maintained.

Nationally, the Care Quality Commission (CQC) has highlighted how PROMISE has created a positive and therapeutic culture across mental health wards at CPFT and reduced the need for restrictive interventions. The scheme features in this CQC guide designed to help mental healthcare providers improve support for patients. In March 2016, the project won a Patient Experience Award for Strengthening The Foundation for mental health care.

Dr Chiara Lombardo, Research Fellow in Global Mental Health, at the Institute for Health and Human Development, University of East London (and the paper’s first author) said: “This study showcases the framework through which a sensitive subject, like coercion in care, can be addressed in a decisive manner. It provides guidance for future culture change, and help to overcome the challenges of running a complex project like PROMISE in another organisation aspiring to improve care like CPFT.”