The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis

“…Association between a child or adolescent's age and being physically restrained. Younger age (<13 years) is associated with an increased likelihood of physical restraint experience in 10 studies (Azeem et al, 2011;dosReis et al, 2010;Duke et al, 2014;Furre et al, 2014;Leidy et al, 2006;Muir-Cochrane et al, 2014;Pogge et al, 2013;Sourander et al, 2002;Stewart et al, 2010Stewart et al, , 2013. Younger children are reported to be more overtly aggressive (Duke et al, 2014;Pogge et al, 2013;Sourander et al, 2002), with aggression being strongly associated with physical restraint.…”

“…A child or adolescent's aggressive acts (defined as harmful behaviour which may include deliberate intent to harm or injure another person (Bandura, 1973, cited in Suris et al, (2004) most frequently trigger the use of physical restraint (Crocker et al, 2010;Delaney and Fogg, 2005;dosReis et al, 2010;Duke et al, 2014;Furre et al, 2016;Muire-Cochrane et al, 2014;Pogge et al, 2013;Sourander et al, 2002;Stewart et al, 2010Stewart et al, , 2013Tompsett et al, 2011), with child-to-staff aggression being identified as a common precursor (Sourander et al, 2002;Tompsett et al, 2011). Studies also associate the use of physical restraint with 'lower level' behaviours (opposition, disinhibition, and absconsion) (Duke et al, 2014;Furre et al, 2016;Muir-Cochrane et al, 2014) as well as destruction of property (Furre et al, 2016;Muir-Cochrane et al, 2014). Self-harming behaviours significantly increase the likelihood of a child or adolescent being physically restrained (Furre et al, 2016;Muir-Cochrane et al, 2014;Stewart et al, 2010), whereas suicidal acts decrease this likelihood in favour of alternative management approaches (Sourander et al, 2002).…”

“…Studies also associate the use of physical restraint with 'lower level' behaviours (opposition, disinhibition, and absconsion) (Duke et al, 2014;Furre et al, 2016;Muir-Cochrane et al, 2014) as well as destruction of property (Furre et al, 2016;Muir-Cochrane et al, 2014). Self-harming behaviours significantly increase the likelihood of a child or adolescent being physically restrained (Furre et al, 2016;Muir-Cochrane et al, 2014;Stewart et al, 2010), whereas suicidal acts decrease this likelihood in favour of alternative management approaches (Sourander et al, 2002).…”

“…Four studies report how multiple interventions were attempted prior to physical restraint (Delaney and Fogg, 2005;Muir-Cochrane et al, 2014;Pogge et al, 2013;Sourander et al, 2002). Delaney and Fogg (2005) report that 'as-needed' medication (typically antipsychotic and/or sedative) was used before 38% (n = 45) of physical restraint incidents, although the authors report that no further information was available to explore the reasons why physical restraint was subsequently implemented.…”

Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint

“…Despite overwhelming support for reducing and eliminating the use of seclusion and restraint, and the success of reduction programs, these practices continue to be used in mental health care (Allan et al 2017;Bowers et al 2017;Bullock et al 2014;Gerace et al 2014;Muir-Cochrane et al 2014;Oster et al 2016;Te Pou o te Whakaaro Nui, 2017). Mental health nurses play a central role in the provision of mental health care and as such represent the staff that are most likely to use seclusion and restraint (NMHCCF, 2009).…”