Understanding Mental Health Service User Experiences of Restraint through Debriefing: A Qualitative Analysis

Abstract

To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients' experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient's experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint.

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“…to keep patients quiet, rather than for therapeutic reasons (Mayers, Keet, Winkler, & Flisher, ; Van Wijk et al., ). This theme connects to the theme “protest behaviour,” as patients reported that professionals reacted unnecessarily aggressively, using coercion, when patients’ “protest behaviour” escalated (Knowles et al., ; Ling, Cleverley, & Perivolaris, ; Rose, Evans, Laker, & Wykes, ). Also, patients requested the opportunity to try out other treatments, therapy, strategies or coping skills before coercive measures were initiated (Meehan et al., ; Katsakou et al., ; Kontio et al., ; Faschingbauer et al., ; Larue et al., ; Knowles et al., ).…”

“…“Protest behaviour” was the result of a perceived loss of autonomy, along with other “negative patient‐perceived impacts” such as anger, frustration and powerlessness. This theme was characterized by patients’ perceptions of themselves as showing verbal and/or physical aggression (Bonner et al., ; Wynn, ; Chien et al., ; Haw et al., ; Faschingbauer et al., ; Van Wijk et al., ; Ling et al., ; Wyder, Bland, Blythe, Matarasso, & Crompton, ) or direct assaults on/violence towards staff or objects (Haw et al., ; Van Wijk et al., ). “Protest behaviour” could also include refusing treatment (Wynn, ), to follow professionals’ directions/rules (Wynn, ; Haw et al., ; Ezeobele et al., ) or was simply perceived by the patients themselves, as bad behaviour (Holmes, Kennedy, & Perron, ; Haw et al., ).…”

“…According to four articles, the “environment” in hospital wards was associated with “negative patient‐perceived impact,” as described in the theme “protest behaviour.” Patients perceived the psychiatric environment to be unsettling and noisy due to the presence of many disturbed patients (Bonner et al., ; Ling et al., ) and compared the hospital ward to a prison (Duxbury & Whittington, ; Rose et al., ). In one study by Kontio et al.…”

“…“Communication” is characterized by patients’ perceptions of insufficient or untrustworthy information provided by professionals (Meehan et al., ; Bonner et al., ; Mayers et al., ; Ling et al., ; Wyder et al., ). This connects to the theme “being subjected to professionals’ control,” as patients in particular perceived a loss of autonomy due to professionals’ behaviour.…”

“…This connects to the theme “being subjected to professionals’ control,” as patients in particular perceived a loss of autonomy due to professionals’ behaviour. Moreover, patients perceived that professionals neglected or ignored when they requested a conversation with the professionals or expressed other specific needs (Bonner et al., ; Duxbury & Whittington, ; Van Wijk et al., ; Ling et al., ; Rose et al., ). “Communication” also connects to the theme “protest behaviour” in that patients perceived professionals to be unhelpful in conversations that might have de‐escalated intensifying “protest behaviour” (Bonner et al., ; Duxbury & Whittington, ; Haw et al., ; Ling et al., ).…”