AimTo evaluate patterns of physical restraint across a mental health trust.IntroductionPhysical restraint has historically been used to manage mental health crises; however there has been a recent trend for reducing this, not least because physical restraint is associated with the risk of physical harm to patients, but also psychological harm and is potentially damaging to therapeutic relationships.A commonly cited reason is violent or aggressive behaviour; however other contributory factors may play a role.We set out to evaluate the characteristics of restrained patients to see if patterns emerged that would explain this.MethodRetrospective review of monthly trust-wide restraint data from 1 January – 30 June 2014.Anonomysed data was collected and analyzed using Excel.All restraints documented through the official reporting system in this period was included.Patient characteristics and reasons for restraint were evaluated.ResultsThe majority of restraints across the trust occurred in Acute Services with 24% on a single ward for Older Adults. 20.7% was recorded on the women's medium secure ward.Within Secure Services there was a significant gender difference in the use of restraint; 94.5% in female wards and 4.5% in male wards. Significant differences in the reasons for restraint were noted. Female patients were mostly restrained for anti-social behaviour or self-harm and male patients for physical assaults.ImplicationsBetter understanding of reasons and patterns relating to use of restraints is likely to assist in developing improved management plans to reduce the overall use of physical restraint in women's services.

SUMMARY Much exists in the literature on filicide and the characteristics of perpetrators and their victims but there is little in the way of practical advice on how to manage perpetrators of filicide in secure psychiatric wards. Clinically, these patients can rapidly respond to medical treatment, only to be faced with the reality of what they have done. In the authors' experiences, certain aspects of their management are particularly challenging due to the emotive nature of their offence. These include managing the interpersonal dynamics on a ward, the media interest that surrounds the case and rehabilitation back into the community. In this article we outline a brief background to filicide in the context of mental illness and describe our experiences of managing the practical difficulties outlined above. The approaches used, outcomes and the supporting evidence base are discussed and illustrated through examples.