Gerard O’Dea here, Director of Training for Dynamis. I’ve been busy these past few weeks with a series of in-depth training engagements with Secure Escort and Patient Transport teams across the United Kingdom.
Our remit has been to help these teams provide safe, professional, and compassionate transport services for people in the care and custody of mental health services. Specifically, we’ve been working on personal safety tactics, restraint interventions, and the communication skills needed to prevent escalation, manage crises, and re-establish stability after incidents of violence or aggression.
The Demands of the Role
The teams we train provide secure transfers throughout the UK for adults, children, and adolescents with mental health illness. Journeys include transfers to and from low, medium, and high secure psychiatric settings; court escorts and attendance for hearings; transfers from police stations, A&E departments, and 136 suites; and journeys to and from outpatient appointments.
In their incredibly varied work, these teams face challenges that must be navigated successfully so that clients can access the high-quality care, treatment, and custody experiences they deserve. On any given day, teams work with:
- People of all shapes, sizes, genders, and mobility levels
- People with varying degrees of capacity and in different states of confusion, dissatisfaction, or boredom
- People who need careful explanations and patient persuasion to collaborate 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 require restraint devices applied to their body following risk assessment
- Environments ranging from easy to navigate to very confined and obstructed
- Handling challenges in, around, and near vehicles — boarding, seated, and dismounting
- Legal decisions about capacity, mental health, medical safety, injury, or illness
The Secure Escort role demands cool heads, calm minds, steely resolve, and a problem-solving approach. These teams are made up of a wide diversity of people who bring their life experience and individual approaches to conflict and vulnerable people into the role.
One of our training tasks is to springboard off individual team members’ ‘unconscious competence’ in working with vulnerable people. Team members are selected for how they habitually treat patients with dignity and show respect — we work to make them consciously aware of specific verbalisation skills and conflict management strategies they can bring to bear across a wide variety of scenarios.
Why Generic Training Falls Short
Dynamis uses a modern, evidence-based approach to training design, working in a highly contextualised way to maximise the time teams spend in training. One of the reasons organisations choose us is that the ‘old way’ — classroom PowerPoint slides and sterile drills within the four walls of a training room — was producing certificated but largely unprepared teams. Staff were immediately improvising new ways of working when their previous training proved unrelated to the real geometry and action of their daily work.
There is a fundamental gap between un-contextualised “off the shelf” training and what’s needed in real operational environments. Those commissioning training for any escort-type work — where teams may need to restrain in or around transport vehicles — should pay careful attention to the inquiry report from Karon Monaghan QC into the death of Jimmy Mubenga.
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.
Karon Monaghan QC, Mubenga Inquiry Report
Despite differences in context — an immigration deportation escort rather than a mental health transfer — similar issues arise in both roles around tactical decision-making and the particular challenges of vehicle-based restraint.
The inquiry raised several concerns about escort staff training. The first three were:
- Scenario-based training: Training in wide-open gym spaces did not replicate the confines of an aircraft or vehicle — seats, centre aisles, and passenger proximity create entirely different challenges.
- Suitability of techniques: Control and Restraint techniques developed for prison environments were being used in aircraft and vehicles — spaces for which they were never designed.
- Practice: The 2008 review had already recommended scenario-based training on aircraft. Years later, the gap remained.
📊 Key finding: Recommendation 4(i) of the Mubenga report states: “Appropriate techniques and bespoke training packages, reflecting the environment in which restraint may need to be applied (aircraft), should be introduced expeditiously.”
Designing Training That Works
Dynamis, as a responsible training provider holding the Institute of Conflict Management’s Quality Award, carries out in-depth training needs analyses focused on job-role tasks, risks, and flashpoints. When we surveyed experienced managers and frontline staff in this role, we discovered that a large proportion of the techniques taught on their induction courses in “Control and Restraint” were useless or redundant.
About 80% of the incidents where restraint skills were needed occurred when approaching, mounting, while seated within, or while dismounting the transport vehicle itself.
The pattern was clear: the existing training was not fit for purpose, staff felt vulnerable both professionally and personally, and unsafe situations were arising for patients. Dynamis needed to design — from the ground up — a new, customised programme of secure escort training and tactics.
In collaboration with Professor Chris Cushion at Loughborough University’s School of Sport, Exercise & Health Sciences — the UK’s premier sports coaching institution — and our team of experienced operational use-of-force specialists, we designed a bespoke training programme. The programme aligns with the Mubenga inquiry findings and differs from previous approaches by giving maximum effective practice time to learners, focusing on context-specific tasks that replicate the real-world challenges teams face when meeting, initiating contact with, inviting, and securely transporting vulnerable people in mental health services.
Feedback from the Frontline
The resulting training programmes are producing well-trained teams who can transport vulnerable people safely, with dignity and respect, on behalf of mental health services colleagues.
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.
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 with new people entering 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 done correctly and safely and that every trainee understood what they were doing and why — to stay safe in their 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