A Matter of Trust and Distrust: A Qualitative Investigation of Parents' Perceptions About the Use of Mechanical Restraint on Their Adult Children in a Forensic Psychiatric Setting

Abstract

Introduction: Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits the evidence base considerably. Aim: The aim of this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients' including factors impacting its use and duration. Method: Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting and thematically analyzed. Findings: Two main themes were identified, namely, “care and protection” and “inclusion and involvement,” and one subtheme, “information.” These themes revealed the framework used by parents to construct a sense of “trust or distrust” about the ability of staff to provide adequate and safe care for their adult children in the forensic psychiatric setting. Conclusion: Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection. However, most parents held strong negative perceptions regarding the use of MR and the quality and safety of care provision. It is apparent that parents in this study believed they should be included and involved in the care in situations associated with the use of MR, because they considered that this could reduce its use. Further research is required to target interventions to reduce the use and duration of MR episodes and to improve clinical practice in forensic psychiatry.

Psychiatric Inpatients’ Lived Experiences of Physical Restraint: A Qualitative Study in Iran

“…After an experience of physical restraint or even its mere observation, the dynamics of patient-staff relationship in the ward may be disturbed drastically and do not revert to the initial state (3). Overall, physical restraint may produce or exacerbate negative emotions that will remain in other forms (10). In the present study, the subtheme of hatred from the theme of oppression suggests this experience.…”

“…Although the hospital staff make efforts to provide a more humane experience of physical restraint, the lack of skilled manpower and a disciplinary approach may be among factors influencing this negative experience, as speculated in a developing country; therefore, comprehensive research is needed in this area. It seems that part of this negative experience is related to physical restraint itself, as in other studies conducted in developed countries, these negative experiences have been repeatedly reported (3,5,7,9,10). Therefore, it is suggested to accept the negative experiences of patients during physical restraint globally, and it should be only used when there is no other option, or there is a risk of harm to oneself or another.…”

“…In a previous review study (5), physical restraint had four consequences, including negative psychological impact, re-traumatization, perceptions of unethical practices, and broken spirit. Since 2010, several remarkable studies have addressed this issue (6)(7)(8)(9)(10). Overall, physi-cal restraint is an experience with both positive and negative outcomes for patients and nurses.…”

“…They believed that the use of these methods was deleterious to their relationship with the patients (1). On the other hand, the positive experiences may include communication between the patients and the staff in case of debriefing and discussing the event (7), safety and understanding, improvement of professional attitude, improvement of information presentation to the patients (11), and genuine calmness and relax-ation (10).…”

Experiences of family caregivers in forensic mental health care—A qualitative evidence synthesis

“…Caregivers had the perception that they were considered to be outsiders, and or not taken seriously in their opinions and knowledge regarding the service user's health, and this led to them feeling ignored and excluded from the care and treatment (Askola et al, 2017; Chemerynska et al, 2020; Finlay‐Carruthers et al, 2018; Paradis‐Gagné, Holmes, & Perron, 2020; Robinson et al, 2017; Rowaert et al, 2017; Sampson et al, 2019). Several caregivers pointed out that HCPs often gave their “duty of confidentiality” as the reason for not responding to caregivers' questions or concern regarding (the service user's) health and treatment, and this led to caregivers feeling excluded (Chemerynska et al, 2020; Paradis‐Gagné, Holmes, & Perron, 2020; Sampson et al, 2019; Tingleff et al, 2019).…”