The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

Abstract

Accessible summary What is known on the subject? There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint. Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan. However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. What this paper adds to existing knowledge? This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended. Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients. Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. What are the implications for practice? To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients. Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. AbstractIntroductionAn international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited.AimsTo evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care.MethodsMixed methods—quality ratings and interviews with relatives and nurses.ResultsPositive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour.DiscussionThe potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed.Implications for practiceMental health professionals implementing PBSPs should engage with relatives and p...

Conceptual framework for a comprehensive competence in managing challenging behaviour: The views of trained instructors

“…We have contributed a preliminary conceptual framework to comprehensively describe the competences healthcare professionals need to successfully manage challenging behaviours. Conceptual clarity is needed, as inadequate conceptual understanding of the competences required for behaviour management may lead to ineffective implementation on interventions (Clark et al., 2020; Price et al., 2016; Tölli et al., 2017).…”

“…BPS has increased staff confidence in a forensic medium secure unit (Davies et al., 2015). Although Clark et al (2020) recognized the potential of PBS to improve psychiatric care, they found that staff were still not always competent at identifying behaviours of distressed people. The successful implementation of Safewards, PBS and other training interventions is connected to staff competence, and comprehensive understanding of staff competence in behaviour management is needed to ensure that these interventions are as effective as possible.…”

Supported decision‐making interventions in mental healthcare: A systematic review of current evidence and implementation barriers

“…47 Clinicians not following or engaging in the intervention protocol was similarly reported in other studies. 29,33,37,46,51,52,59,74,99,100 More experienced clinicians were found to be associated with lower completion rates of crisis plans with service users. 81 In addition, several studies reported that substantial effort or support was required for clinicians to change their approaches and routine practices.…”

“…For example, clinicians were reported as being disrespectful of service users by being inconsistent (saying or promising one thing and doing something else), condescending, patronising and judgemental, by not listening, not taking the time to explain matters and not respecting service users' wishes. 29,42,47,50,51,64,71,84,86,96,97 Furthermore, many clinicians were resistant to changing their practices to accommodate shared or supported decision-making in treatment planning. For example, in one study, no psychiatrists went to service-wide training attended by 350 other health professionals.…”

Caring for behaviorally challenging patients in nonpsychiatric settings

“…4 Disruptive patient behavior occurs in inpatient psychiatric settings with a lax ward structure, unclear and inconsistent implementation of hospital rules, and poorly defined staff roles. 1,[5][6][7] However, the impact of disruptive or unsafe behaviors on patient care in EDs and nonpsychiatric medical inpatient units is not well reported. This article explores the use of a behavior support plan (BSP) to address disruptive patient behaviors and ensure the safe delivery of patient care.…”