Trauma for all: a pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK

Abstract

Violence and aggression is common in psychiatric inpatient units. Despite the near universal prevalence of restraint, there is very little published research on either the efficacy or the subjective effects of restraint on staff or patients. In this pilot study, semistructured interviews were given to the patients and staff involved in six untoward incidents in which the patient participant had been subject to manual physical restraint. Participants were interviewed as soon as possible after the occurrence of the incidents. The interviews asked the patient and staff participants to identify and discuss the factors that they found helpful and unhelpful during and in the immediate aftermath of these incidents. The incidents generated strong emotions for all concerned. The patients valued staff time and attention but felt that they received too little attention. Both nurses and patients discriminated between permanent and temporary staff. Patients reported feeling upset, distressed and ignored prior to the incidents and isolated and ashamed afterwards. Postincident debriefing was valued by all but was patchy for staff and rarer still for patients. Patients feared the possibility of being restrained. Half of the patients and several staff members reported that the incidents had reawakened distressing memories of previous traumatic events. Further research on the subjective effects of restraint is urgently needed.

Restraining good practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK)

“…The results of the search indicated that in the last 14 years relevant studies equated to seven published papers. Of the seven studies identified; four were qualitative studies (Bonner et al 2002;Fish & Culshaw, 2005;Jones & Kroese, 2006;Perkins et al 2012), one study used mixed methods (Duxbury et al 2002), one study made use of a survey comprising of quantitative and qualitative questions (Lees et al 2003) and one was a quantitative study (Foster et al 2007). See Table 1 below for an overview of the studies.…”

“…Five of the studies (Duxbury 2002;Lees et al 2003;Fish & Culshaw, 2005;Foster et al 2007;Perkins et al 2012) gave voice specifically to mental health professionals regarding the use of restraint, while three (Bonner et al 2002;Duxbury 2002;Jones & Kroese, 2006 ) offered a voice to the service user.…”

“…Five of the studies used small samples (Bonner et al 2002;Duxbury 2002;Fish & Culshaw, 2005;Jones & Kroese, 2006;Perkins et al 2012), while Lees et al's (2003) study had a low response rate and, focusing on the last incident of restraint, had the potential to create bias.…”

“…Service users felt that approaches on the part of the staff were controlling in nature, believing that poor communication and environmental factors often precede episodes of aggression (Bonner et al 2002;Duxbury, 2002;Fish & Culshaw, 2005;Jones & Kroese, 2006). The notion of using restraint as a way of controlling behaviour was evident in five of the studies (Lees et al 2003;Fish & Culshaw, 2005;Jones & Kroese, 2006;Foster et al 2007;Perkins et al 2012).…”

“…However, it was also reported that fear of aggression may motivate staff to use physical means, such as restraint and/or seclusion, to manage what is considered to be unacceptable behaviour (Bonner et al 2002;Duxbury 2002;Foster et al 2007). With regard to fear as a motivator, the nurses in Perkins et al's (2012) study articulated how knowing a patient meant that they were aware of their pattern of behaviour and trigger points to aggression, making risk more predictable and de-escalation possible.…”