16. Coercive Practices in Mental Health Services: Stories of Recalcitrance, Resistance, and Legitimation

McKeown, Michael; Scholes, Amy; Jones, Fiona; Aindow, Will

doi:10.3138/9781442629981-023

Cited by 13 publications

(6 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This chimes in with policy and practice support for an ethos of co‐production (Fisher, ), arguably supporting broader shifts towards democratized relations of care (McKeown, Edgar, Spandler, & Carey, ). Critics call attention to epistemic and cultural barriers to the realization of such desirable goals (Liegghio, ) and nursing's complicity within cycles of violence (Gadsby, ; McKeown, Scholes, Jones, & Aindow, ). Notwithstanding such critique, an appreciably formidable stumbling block would appear to be prevailing vicissitudes of denuded staffing levels, which clearly obstruct teams’ capacities to enact relational approaches to care.…”

Section: Discussionmentioning

confidence: 99%

“…This chimes in with policy and practice support for an ethos of co-production (Fisher, 2016), arguably supporting broader shifts towards democratized relations of care (McKeown, Edgar, Spandler, & Carey, 2018). Critics call attention to epistemic and cultural barriers to the realization of such desirable goals (Liegghio, 2013) and nursing's complicity within cycles of violence (Gadsby, 2018;McKeown, Scholes, Jones, & Aindow, 2019).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

McKeown

Thomson

Scholes

et al. 2019

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

Accessible summary What is known on the subject? Mental health nursing in the UK and other countries faces an acute workforce crisis. Safe staffing levels are called for, and in some jurisdictions have been legislated for. The evidence base linking staffing levels and patient outcomes is limited. Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this. Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. What does this paper add to existing knowledge? Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project. Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face‐to‐face contact between nurses and service users. Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it. Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de‐escalation, were also attributed to staffing levels. There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. What are the implications for practice? Efforts to reduce restrictive practices will be hampered without adequate staffing levels. Restrictive practices may justifyably be framed as an employment relations matter. Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. Abstract IntroductionSafe staffing and coercive practices are of pressing concern for mental health services. These are inter‐dependent, and the relationship is under‐researched. AimTo explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. MethodsThematic analysis of semi‐structured interviews with staff (n = 130) and service users (n = 32). ResultsFive themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes—“insufficient staff to do the job”; “detriment to staff and service users”; “a paperwork exercise: the burden of non‐clinical tasks”; “false economies”; and, “you can't do these interventions.” DiscussionTendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developm...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

McKeown

Thomson

Scholes

et al. 2019

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

show abstract

“…Similarly, these narratives operate to induct and socialise staff into prevailing cultures of coercion and control (Chapman , McKeown et al . 2019a).…”

Section: Discussionmentioning

confidence: 99%

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study

McKeown

Thomson

Scholes

et al. 2019

Sociology Health & Illness

View full text Add to dashboard Cite

Coercive practices, such as physical restraint, are used globally to respond to violent, aggressive and other behaviours displayed by mental health service users.1 A number of approaches have been designed to aid staff working within services to minimise the use of restraint and other restrictive practices. One such approach, the ‘REsTRAIN Yourself’ (RYS) initiative, has been evaluated in the UK. Rapid ethnography was used to explore the aspects of organisational culture and staff behaviour exhibited by teams of staff working within 14 acute admission mental health wards in the North West region of the English NHS. Findings comprise four core themes of space and place; legitimation; meaningful activity; and, therapeutic engagement that represent characteristics of daily life on the wards before and after implementation of the RYS intervention. Tensions between staff commitments to therapeutic relations and constraining factors were revealed in demarcations of ward space and limitations on availability of meaningful activities. The physical, relational and discursive means by which ward spaces are segregated prompts attention to the observed materialities of routine care. Legitimation was identified as a crucial discursive practice in the context of staff reliance upon coercion. Trauma‐informed care represents a potentially alternative legitimacy.

show abstract

“…In addition, it is well known that patients and staff often hold different perspectives on coercive events and thereby both parties will claim legitimacy for their actions (McKeown et al . ). However, it is suggested that forensic patients, compared to general psychiatric patients, are more likely to perceive violence and aggression as unavoidable factors associated with their illness and personality, thus, could therefore be more realistic about the necessity of applying coercive measures (Dickens et al .…”

Section: Discussionmentioning

confidence: 97%

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

Tingleff

Hounsgaard

Bradley³

et al. 2018

Int J Mental Health Nurs

View full text Add to dashboard Cite

To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence‐based patient care, we need more knowledge about patients’ subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients’ perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: ‘overt protest reactions’, ‘silent protest reactions’, ‘illness‐related behaviour’, and ‘genuinely calm’, which together characterize patients’ perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: ‘pattern of protest’ and ‘pattern of illness’. Further research is needed to illuminate the associations between patients’ perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.

show abstract

16. Coercive Practices in Mental Health Services: Stories of Recalcitrance, Resistance, and Legitimation

Cited by 13 publications

References 32 publications

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

Contact Info

Product

Resources

About