Patients’ and staff members’ experiences of restrictive practices in acute mental health in-patient settings: systematic review and thematic synthesis

Abstract

Background Recent guidance has called for the reduction of restrictive practice use owing to growing concerns over the harmful physical and psychological effects for both patients and staff. Despite concerns and efforts, these measures continue to be used regularly to manage challenging behaviour in psychiatric in-patient settings. Aims To undertake a systematic review of patients’ and staff members’ experiences of restrictive practices in acute psychiatric in-patient settings. Method A systematic review and thematic synthesis was conducted using data from 21 qualitative papers identified from a systematic search across three electronic databases (PsycInfo, Embase and MEDLINE) and citation searching. The protocol for the review was pre-registered on PROSPERO (CRD42020176859). The quality of included papers was examined using the Critical Appraisal Skills Programme (CASP). Results Four overarching themes emerged from the experiences of patients: the psychological effects, staff communication, loss of human rights and making changes. Likewise, the analysis of staff data produced four themes: the need for restrictive practices, the psychological impact, decision-making and making changes. Patient and staff experiences of restrictive practices were overwhelmingly negative, and their use carried harmful physical and psychological consequences. Lack of support following restraint events was a problem for both groups. Conclusions Future programmes seeking to improve or reduce restrictive practices should consider the provision of staff training covering behaviour management and de-escalation techniques, offering psychological support to both patients and staff, the importance of effective staff–patient communication and the availability of alternatives.

Are principles of recovery-oriented practice evident in staff and service user perspectives on seclusion?

“…These findings should be considered in the context of increasing calls for reductions in restrictive practices in mental health settings (Muir-Cochrane et al , 2018) and the evidence for negative outcomes associated with these practices (Butterworth et al , 2022). In addition, models such as Safewards (Mullen et al , 2022) and trauma-informed approaches (Bloom and Farragher, 2013; Ross, 2020) offer alternatives to harmful restrictive practices.…”

We have to cancel psychiatric nursing and forge a new way forward

“…Yet, the lowest proportions of people reporting a positive experience of mental health care are those subjected to involuntary inpatient hospital stays (Loughhead et al., 2023). There is overwhelming evidence that restrictive practices such as physical and chemical restraint and seclusion cause significant psychological distress and harm including feeling threatened, dehumanised, fearful, angry, anxious and re‐traumatised (Bendall et al., 2022; Butterworth et al., 2022). This is despite the clinical effectiveness of restrictive practices in treating ‘serious mental disorders’ not being supported by available scientific evidence (Zaami et al., 2020).…”

Healthcare staff's experiences of using manual physical restraint: A meta‐synthesis review

“…More recently, Butterworth et al (2022) conducted a review and thematic synthesis of the qualitative research literature on staff's and service users' experiences of restrictive interventions. However, like Riahi et al (2016), this review focused on several types of restrictive interventions (e.g., manual, mechanical, and chemical restraint) within inpatient acute mental health settings only, and the authors did not include key studies exploring inpatient acute mental health staff members' experiences of manual restraint (e.g., Bailey et al, 2021; Perkins et al, 2012).…”