The study examines the experiences of physical restraint procedures reported by nursing staff in a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Nursing staff reported a range of emotional responses to the use of restraint procedures. They included anxiety, anger, boredom, distress and crying. In some cases these responses were confirmed by descriptions from patients.Staff coped with the emotional responses to restraint in a variety of ways. Some staff discussed the ‘stigma’ attached to showing feelings to other staff. They described how laughter was used to reduce stress following an incident and how distressing emotions had to be taken home. Some staff described how they had become ‘hardened’ to the experience of restraint. A substantial proportion of staff suggested that they had ‘no’ emotional reactions and many reported ‘automatic’ responding during a restraint event in which they did not feel any emotion.Possible implications of these responses and clinical practice are discussed.

This study examines the experiences of physical restraint procedures reported by in‐patients of a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Patients had differential experiences of similar physical procedures. Most reported some negative psychological experience of restraint. Anger and anxiety were two major themes. Some respondents held the perception that restraint was used to punish patients and several suggested that restraint incited further violence and aggression. Some female service users reported that restraint evoked flashbacks of previous sexual trauma.A subset of female respondents gave contrasting accounts of restraint, suggesting that they purposely brought about the restraint to gain a sense of containment or as a way to release feelings.Possible implications of these responses for clinical practice are discussed.

In terms of reconviction, these results are good compared with those from general forensic services; however, behavioural problems continue for many years and are managed without recourse to the criminal justice system. There is a borderline group whose needs are poorly defined and serviced. Declaration of interests Horizon National Health Service Trust, the managing authority of the service, gave the grant for this study; the corresponding author was working in the service.

In a sample of 120 long-stay in-patients who fulfilled DSM-III-R criteria for schizophrenia, chronic akathisia and pseudoakathisia were relatively common, with prevalence figures of 24% and 18%, respectively. Compared with patients without evidence of chronic akathisia, those patients with the condition were significantly younger, were receiving significantly higher doses of antipsychotic medication, and were more likely to be receiving a depot antipsychotic. Patients who experienced the characteristic inner restlessness and compulsion to move of akathisia also reported marked symptoms of dysphoria, namely tension, panic, irritability and impatience. The findings support the suggestion that dysphoric mood is an important feature of akathisia. Male patients appeared to be at an increased risk of pseudoakathisia. No significant relation was found between chronic akathisia and tardive dyskinesia, although there was a trend for trunk and limb dyskinesia to be commonest in patients with chronic akathisia while orofacial dyskinesia was most frequently observed in those with pseudoakathisia. Akathisia may mask the movements of tardive dyskinesia in the lower limb. There was no evidence that akathisia was associated with positive or negative symptoms of schizophrenia nor with depression.

Thirty‐five patients who had received at least one year's treatment in a learning‐disability medium secure unit were followed up for a maximum of five years. A good treatment outcome was more common in those with significant learning disability. At the end of follow‐up, 21 subjects (60%) were living in the community with support. The early months after discharge were a peak period for relapse. A very low level of reconviction was found, affecting only one subject. Patients who were older on discharge were less likely to re‐offend. The two deaths that occurred during follow‐up, and the three patients who required special (high security) hospital referral, are reported in detail. The findings are contrasted with the only comparable study (Day, 1988).