"It's important for staff to be properly trained before using 'Time Out'."

Gary Butler (UK)

In this article Janet Carr explains how a programme of behaviour management can help people learn new skills and stop being so challenging to the people who support them. It is positive to find things for people to do to stop them doing other challenging behaviours. I don't know what can stop them switching back to the old behaviour pattern later. Maybe the new ways of behaviour are more enjoyable than the old ones, so they don't come back. It seems to me that a lot depends on what you call a challenging behaviour. I wonder why we only describe people with learning disabilities as having challenging behaviours? I think football fans have challenging behaviours, especially when they have had a few drinks.

There are some bits of this paper that I really agree with - like finding out what people like and what makes them tick. I think the point about people with learning disabilities wanting even negative attention is valid, but if that is all they get, how can they learn? The bit about 'Time Out' worries me a lot. It's like people are being punished for behaving that way. Won't they think "why have I been put in here on my own?" Couldn't health professionals take the person out of the room and just gently talk to them? They could hurt themselves. Sometimes that is the case if they are sent out of the room for longer than 5 minutes. I've seen it happen. Dr Carr stresses that this should never be for more than 5 minutes and that it can help. But I've been to a day care centre and live in a residential care home, and have seen how staff can be threatened by difficult behaviour. They don't have the training to understand why someone is behaving in a particular way, and they sometimes put them in a room alone for a long time. Then the person gets more and more frustrated and behaves worse. Something I have seen happen is people slapping their head when they cannot speak and say why they are doing it. They might be put in a room to calm them down without anyone asking if they have an earache or a headache.

I just want everyone to be trained before using 'Time Out' and, as Dr Carr says in her article, make sure that everyone who is challenging is treated as sensitively as possible.

Gary Butler is a Training Adviser in the Department of Mental Health, St George's, University of London. This commentary was drafted following a discussion with two colleagues.