The use of positive behaviour support plans in mental health inpatient care: A mixed methods study
Authors: Clark Louise L. , Lekkai Fiorinta , Murphy Anthony , Perrino Luisa , Bapir‐Tardy Savin , Barley Elizabeth Alexandra 
Published: September 2019

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.

Introduction

An 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.

Aims

To 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.

Methods

Mixed methods—quality ratings and interviews with relatives and nurses.

Results

Positive 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.

Discussion

The 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 practice

Mental health professionals implementing PBSPs should engage with relatives and patients, gain organizational commitment and ensure that those involved understand fully the positive behaviour support approach.