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July 9, 2018

Mental Health Escort Training: excellent Feedback from Frontline and Management

Secure Escort Training: modern, relevant, pragmatic.

Hello!  Gerard O’Dea here, Director of Training for Dynamis and I have been busy these past few weeks with a series of in-depth training engagements with Secure Escort and Patient Transport teams.   Our secure escort training remit has been to provide help to these teams who provide safe transport services in the most professional and compassionate way possible for people in the care and custody of mental health services all over the United Kingdom.   Specifically we have been working on personal safety tactics, restraint interventions and the communication skills which must be employed to prevent escalation, deal with crises or reestablish stability after an incident of violence or aggression.

The teams we train are tasked with providing secure transfers throughout the UK for adults, children and adolescents with mental health illness. Journeys have included:

• to and from low, medium and high secure psychiatric settings
• court escort and attendance for hearings including transfers to and from prisons and courts
• from police stations, A&E departments, 136 suites
• to and from outpatient appointments

In their incredibly varied work, these teams come across all kinds of challenges that must be navigated successfully so that their clients can access the high-quality care, treatment and custody experiences that they deserve and need.   However on a given day the teams will work with:

  • people of all shapes and sizes, genders and mobility levels
  • people with varying degrees of capacity and in different states of perhaps confusion, dissatisfaction or boredom
  • people who need careful explanations and patient persuasion to collaborate or cooperate with their treatment plans
  • people who are actively physically aggressive and resistant towards the team, the vehicle or others
  • people whose behaviour can change suddenly from settled to highly anxious or frustrated
  • people who (through risk assessment) must have restraint devices applied to their body
  • environments which are easy to navigate and move around in, or very confined and with obstructions
  • handling challenges in, around, near to and up/down into/out of vehicles
  • legal decisions about capacity, mental health, medical safety, injury or illness

To say the least, the Ambulance Care Assistant or Secure Escort role is a demanding one and requires cool heads, calm minds, steely resolve and a problem-solving approach.   It has been interesting to observe during the secure escort training that these teams are made up of a wide diversity of people who all bring their life-experience, their approaches to conflict and working with vulnerable people, to the role.  One of our secure escort training tasks with these teams is to springboard off individual team-members’ ‘unconscious competence’ in working with vulnerable people.  The team members are selected for how they habitually treat patients with dignity and show respect, so we work to make the team consciously aware of specific verbalisation skills and conflict management strategies they can bring to bear on a wide variety of scenarios they find themselves in.

Dynamis uses a modern evidence-based approach to the training design and the structure of the learning for these teams, working in a highly contextualised way to make the most of the time-in-training that the teams have.   In fact, one of the reasons these companies are choosing Dynamis, is that the ‘old way’ of training these teams, through classroom Powerpoint slides and sterile drills within the “four walls” of the classroom was producing certificated, but largely un-prepared teams who were immediately having to improvise new ways of working when their previous secure escort training was found to be unrelated to the real geometry and action of their daily work.  Part of our work is to make the teams see the issues that attend to their specific work role and to offer strategies which are efficient and workable, but also we spend training time on having the teams learn how to work in cooperation with one another to solve problems as they arise.

Importantly, in talking about the wider significance of the secure escort training design on operational efficacy, there is a fundamental gap between un-contextualised “off the shelf” training and the type of training needed in real operational environments.   Those commissioning training for any ‘escort’ type of work in which teams may need to restrain in or around transport vehicles should pay careful heed to the inquiry report from Karon Monaghan QC into the death of Jimmy Mubenga.  Despite the difference in context (an immigration deportation escort as opposed to a mental health transfer escort) there are similar issues in both roles in terms of tactical decision-making and the particular issues which arise during the tasks.

In her inquiry report, Karon Monaghan QC raised several concerns about the training of the staff providing the escort function, of which the first three were:

(1) scenario based training; (2) use of C+R on an aircraft; (3) practice;

Firstly, the training provided by G4S trainers to DCOs was generally delivered in a wide-open space, in a gym or dojo, and although some “dynamic” scenarios were created (with trainees putting into practice the techniques learnt against instructors resisting to some degree), the environment in which the training took place did not replicate that of an aeroplane.…on any analysis the absence of training in an environment which reflected the context in which C&R might have to be used constituted a significant training gap.


The need for scenario based training, in particular on an aircraft with a centre isle and passenger seats on both sides, had already been the subject of a recommendation following a review in 2008.


Secondly, there were many concerns raised during the course of the hearing, in particular by G4S trainers, as to the suitability of C&R for use in the confines of an aircraft at all. C&R was developed by the National Offender Management Service (NOMS) (an executive agency of the Ministry of Justice) primarily for use by prison officers in prison environments or in prison vehicles; that is, not for use on an aircraft. The “Use of Force” training manual did take account of the fact that in a prison environment force may have to be used in a confined space, such as where it is necessary to move a prisoner through a narrow doorway or up spiral staircases or within a vehicle. However, restraint on a scheduled flight with passengers and crew in very close proximity and in particularly narrow spaces, may present very specific challenges.


Recommendation 4 (i) of the report is that:  

“Appropriate techniques and bespoke training packages, reflecting the environment in which restraint may need to be applied (aircraft), should be introduced expeditiously.”


You my read the full report here:   http://iapdeathsincustody.independent.gov.uk/wp-content/uploads/2013/12/Rule-43-Report-Jimmy-Mubenga.pdf


Dynamis, as a responsible secure escort training provider with the Institute of Conflict Management’s Quality Award, carries out in-depth training needs analyses on client requirements, specifically focussing on job-role tasks and their risks and flashpoints before and during all training courses delivered by us, to inform our training design.   Importantly, when we surveyed the managers and frontline staff who are experienced in this role, what we found was that a large amount of the training techniques that the teams were taught on their induction courses in “Control and Restraint” were useless or redundant.   We also discovered that about 80% of the incidents where those skills were needed, were needed when approaching, mounting, while seated within or while dismounting the transport vehicle itself.   It became clear that A) the other training was not fit for purpose, therefore B) the staff were feeling vulnerable professionally and personally, leading to C) unsafe situations arising for the patient and therefore D) Dynamis needed to design, from the ground-up a new and customised programme of secure escort training and tactics for these teams.


In collaboration with our academic colleague Professor Chris Cushion at the School of Sport, Exercise & Health Sciences at Loughborough University the UK’s premier sports coaching institution and our team of experienced operational use-of-force specialists, we designed a bespoke training programme for secure escort staff.  One of the design requirements was that the training programme would fall in line with the Mubenga inquiry report findings.  Our programme differs from others delivered previously in the sector because it endeavours to give maximum effective practice time to our learners.  Furthermore, it focusses on context-specific tasks which replicate the anticipated real-world challenges the teams face as they meet, initiate contact with, invite and securely transport vulnerable people in mental health services.


As you can see from our recent feedback, below, the resulting secure escort training programmes are producing well-trained teams of staff who can transport vulnerable people safely, with dignity and while showing them respect, on behalf of our mental health services colleagues.   [If you want to learn more about these courses, please click on this link.]


“Exceeded all the criteria we needed to achieve, interesting, interactive, informative and enjoyable.  A really impressive course in all aspects, my team came away visibly more confident and closer as a team, i am certain the experience will give us the right foundations enabling excellent care to the patients we manage. a sincere thanks Gerard.”

Director of Care and Quality, Secure Escort Patient Transport Service, North of England, June 2018 

“Very useful techniques put across in an excellent way that could be understood.  Gerard was thorough and professional 👌

Ambulance Care Assistant, Mental Health Team, East Anglia, June 2018

“Gerard was brilliant and very good with new people entering into a new job role, he took time to make sure we got it right and didn’t settle for anything less than perfect. Even in the boiling hot weather he made sure everything was all done correctly and Safely and that every trainee understood what he was saying or doing. Gerard was very good and made sure everyone was doing and why we were doing what was meant to be done to be safe in our new job role.”

Mental health transport/ACA, Patient Transport (Secure), Norwich, July 2018

“Trainer had a wealth of experience in the subject and was an ideal fit for what we were looking for, as were all aspects of the training. Extremely likely (10/10) to recommend to colleagues.  “

Director of Services, Ambulance, Patient Transport and Secure Escort Services Company, North-West England, July 2018

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Gerard O'Dea

Gerard O'Dea is the Director of Training for Dynamis. Training Advisor, Speaker, Author and Expert Witness on Personal Safety, Conflict Management and Physical Interventions, he is the European Advisor for Vistelar Conflict Management, a global programme focussing on the spectrum of human conflict.

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