COVID-19 Message from Martyn Dadds MD, CPI International

Date: 1st April 2020

Dear colleagues

Guidance to Certified Instructors: Responding to questions from frontline staff who may have to consider the use of restrictive physical interventions in the workplace amid concerns about Covid-19

Once again thank you for all your efforts. As I have previously said, CPI continues to take on the learning from the current crisis so that we can continue to operate effectively and adapt how we support you in the light of prevailing guidance on Covid-19.

Over the past week, more and more Certified Instructors have requested guidance from CPI about providing ongoing training to frontline staff. In our last email and on our website, we outlined various ways you and you organisation may offer training so that you can continue to ensure frontline staff acquire and maintain the knowledge and skills they need.

Some Certified Instructor have also been asking for advice on whether frontline staff should use physical interventions if there is a risk of infection. ‘How can staff safely intervene in a way that doesn’t place them at an increased risk of infection?’ is a question that I’m sure many of you have been asked or will be asked by your colleagues.

Firstly, any advice given to frontline staff on this matter should be authorised, approved and issued by your organisation in accordance with Public Health and Government guidelines on Covid-19. There is a lot of information circulating which is sometimes inaccurate or misleading causing unnecessary anxiety in staff teams. Having clear and consistent guidance from your organisation helps to avoid confusion and may ease staff anxieties especially if the advice given is based on information from a credible source such as a Government department, professional body or academic institution, published research, and/or guidance and advice from a recognised specialist (eg infection control specialist).

Secondly, it is important to remember that we at CPI are not occupational health specialists or specialists in infection control, so our advice to all customers is to review their own internal infection control procedures for all activities that involve direct physical contact or other close personal interactions, including the use of physical interventions, to ensure staff are provided with the right personal protective equipment (PPE) and are trained in its use.

Our curriculum is accompanied by an independent risk assessment which assesses the risks associated with the use of the physical interventions to staff and to the individual who is subject to such restrictions. This assessment is based on a ‘typical person’ because the independent assessor and external panel who reviewed the assessment, could not take account of each person’s unique physiological and psychological factors that may elevate the risks when used in a ‘real world’ event.

As such, the risk assessment should be used to guide further assessments staff undertake in their workplace. Staff are advised to use this assessment to help in the development of people’s individual support plans so that interventions can be authorised and approved which are specific to the individual thereby maximising safety and minimising harm for everyone. All staff have a duty of care to maintain the Care, Welfare, Safety and Security of everyone and any decision to use restrictive physical interventions with an individual who is known to or believed to have any communicable infection should take account of any suitable and appropriate PPE required to maintain staff safety aa well as identifying those interventions that are not appropriate and/or safe to perform.

With regard to specific advice related to the use of physical interventions with an individual who has an infectious disease (Covid-19 or other infection), then we would direct all Certified Instructors to their organisation’s policy on infection control and consider how safe infection control measures can be implemented. As previously stated, CPI is advising that any advice issued to staff regarding the use of physical interventions reflects the current guidance issued by the Government, public health and guidance provided by an infection control specialist.

There is little credible guidance or research on the use of physical interventions and infection control, or guidance specifically related to Covid-19. CPI is actively tracking any guidance or publications currently available and will ensure we keep you up to date as much as we can. The links and attachments with this briefing may help you and your organisation reach an appropriate and safe decision.

  • Skills for Care. A statement on Covid-19 and the Mental Capacity Act

  • National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU). Guidance for staff working in secure mental health settings

  • National Institute for Health and Care Excellence (NICE): Current Covid-19 guidance for specific health and social care settings

  • Damir Huremović (Ed) (2019) Psychiatry of Pandemics A Mental Health Response to Infection Outbreak.

  • Centre for the Study of Traumatic Stress (CSTSS): Guidance for Medical and Mental Health clinicians LINK 1 | LINK 2

  • Zu et al 2020 The Risk and Prevention of Novel Coronavirus Pneumonia Infections Among Inpatients in Psychiatric Hospitals. Neuroscience Bulletin, March, 2020, 36(3):299–302