Exploring experiences of restrictive practices within inpatient mental healthcare from the perspectives of patients and staff

Objective: To explore experiences of restrictive practices from the perspectives of acute care inpatients and staff.

Method: Qualitative semi-structured interviews were undertaken exploring participants’ experiences deemed to involve restrictive practices. Additionally, a period of observational fieldwork was undertaken. Nine inpatient participants and eight staff member participants were recruited across two adult psychiatric wards. Data were analysed using thematic analysis.

Results: Analysis of data from the inpatient participants identified three superordinate themes including ‘Overpowered by staff’, ‘Making sense of restrictive practices’ and ‘Surviving restrictive practices’. Analysis of data from staff member participants identified three superordinate themes including ‘Legitimate practices’, ‘Impact’ and ‘Strategies to avoid restrictive practices’. Our analysis found a key discrepancy in how alternatives to restrictive practices were experienced by patients, where staff felt they were able to use ‘negotiation’ with patients, whereas patients experienced these approaches as coercive.

Conclusion: Whilst some positive experiences are noted by patients and staff, restrictive practices continue to be experienced negatively by both patients and staff, supporting the current focus on reducing the use of restrictive practices in the acute care setting. The use of de-escalation and other alternative interventions to restrictive practices are experienced differently by patients and staff and further research is required to examine the use of these alternative strategies.