Restraining good practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK)

Abstract

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman or degrading treatment, and having the right to liberty, security, respect and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature findings revealed restraint can be a form of abuse, it's inappropriate use often being a consequence of fear, neglect and lack of using de-escalation techniques.Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike.

An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings

“…Good mental health nursing is predicated on therapeutic partnerships between service users and staff (Warne & McAndrew ), with good communication and interpersonal skills having the potential to prevent or minimize the need for restraint (Cusack et al . ). In the light of this and the evidence presented in this study, mental health nurses are well positioned to use their skills and knowledge positively to promote therapeutic engagement and eradicate physical restraint.…”

“…For some time, progressive and critical service users have expressed concerns about the legitimacy and potentially harmful impact of coercion and restrictive practices (Cusack et al . ; Duxbury ; McKeown et al . ; Rose et al .…”

“…; Whitlock ), others believe they would not be taken seriously when reporting such practice (Cusack et al . ; Whitlock ). For some nurses, restraint is seen as a ‘necessary evil’ in controlling behaviour and preventing violence, thus leading to the normalization of restraint practice (Perkins et al .…”

Service user perspectives on coercion and restraint in mental health

“…Reviewing evidence of the effects of restraint, Cusack et al ( 2016 ) concluded that ‘restraint can be a form of abuse, its inappropriate use often being a consequence of fear, neglect and lack of using de-escalation techniques’.…”

Patient Self-Harm in the Emergency Department: An Evidence- Based Approach

“…As mentioned in this chapter's clinical vignette, restraints may not eliminate the risk of DSH. Therefore, the choice to use PhyR continues to be controversial and should only be entertained as a last resort option when there exists a real possibility of serious physical injury to self or others [63][64][65]. There is therefore a need for caution and balanced judgment on part of the treatment team, beginning with a well-informed understanding of potential complications and safety procedures designed to prevent adverse outcomes [63][64][65].…”