Sensory modulation in Acute Mental Health wards: a qualitative study of staff and service user perspectives
The goal of reducing seclusion and restraint in acute mental health services has resulted in the exploration of alternative methods for managing agitated and aggressive behaviour (OHagan, 2006). Sensory modulation intervention has been identified as a potential alternative to more coercive practices by supporting service users to self-regulate when distressed or agitated within acute mental health settings. The approach utilises sensory based equipment, strategies and environments to assist people in optimizing arousal levels and engagement in everyday life. This is an emerging approach within mental health care and there is a need for further research to support its development and application, and provide evidence of its efficacy. The purpose of the research outlined in this report was to explore the feasibility of using sensory interventions in acute psychiatric services with the specific aims of:
• Understanding service users’ experience of using sensory modulation as a tool for the de-escalation of arousal. • Exploring staff member perspectives of using sensory modulation as an intervention for the de-escalation of arousal. • To identify specific facilitators and barriers to implementing sensory modulation interventions in acute mental health wards.
The qualitative data reported in this document was gathered through service user and staff focus groups and individual interviews. Thematic analysis of the data provided insights into the process and outcomes of sensory modulation practice. The findings suggest that sensory interventions are viewed by both staff and service users as being effective in modulating arousal and promoting de-escalation. Three key outcomes of sensory modulation were identified in the participant accounts, all of which support de-escalation of arousal:
• Sensory modulation was perceived as an effective tool for inducing a calm state in the majority of people that used it. • Sensory modulation supported the rapid building of trust and rapport for both service users and staff members. • Sensory modulation facilitated the development of service users’ self-management, increasing their awareness and ability to regulate their own arousal levels.
In addition to these intervention outcomes, the findings shed light on the process of sensory modulation and specifically the mechanisms that support the above outcomes. Seven aspects of the intervention were noted as being significant in the participant accounts:
• Creating a sense of safety • Soothing through the sensory input • Distracting attention from distressing thoughts, emotions and perceptions • Stabilising or ‘grounding’ through the sensory input • Creating positive associations • Creating a sense of control • Supporting expression and release of thoughts, emotion and energy.
These mechanisms interacted in a dynamic process as service users shifted their attention to their bodies and immediate environment, and engaged in a whole sensory experience created by the room, equipment and the supportive presence of a staff member. The findings also highlighted important considerations in implementing the sensory modulation approach; including the set up of the room and use of specific equipment, how staff members can best support service users to access and benefit from the intervention and what organisations need to consider when developing and maintaining a sensory approach within an inpatient service. Overall, participant responses reflected a high level of acceptability and a belief in the efficacy of the intervention. However, sensory modulation must be seen as one component of organisational change process if it is to have an impact on seclusion and restraint rates. Attention needs to be given to relevant policies, leadership and training if the intervention is to be used effectively as a routine and effective addition to practice.