Women’s experiences of restrictive interventions within inpatient mental health services: A qualitative investigation

Abstract

Restrictive interventions (RI), such as physical restraint, seclusion, and rapid tranquilization, can have negative psychological effects on service users; however, there has been little investigation regarding their effects on women. The aim of this paper was to explore women's experiences of RI within UK inpatient mental health services. Twenty women accessing inpatient mental health services participated in semi-structured interviews. Using thematic analysis (TA), three primary themes were reported from women's experiences: (1) powerlessness, (2) dehumanization, and (3) relationships and communication. Clinical recommendations included ensuring gender-awareness and trauma-informed care training is mandatory for all mental health staff, for RI training to include awareness of gender differences, and for policies to be reviewed with regard to women being invasively searched and ensuring sanitary products are safely available for women within seclusion. Directions for future research include investigating the experiences of RI for women from minority ethnic groups and exploring important moderators and mediators in the relationship between RI and re-traumatization for women.

Adverse mental health inpatient experiences: Qualitative systematic review of international literature and development of a conceptual framework

“…Patients said they wanted to feel cared for, yet instead felt punished or dehumanised by staff; this was perceived as an injustice, and left patients feeling their views were unimportant or disregarded. 32, 50, 80, 81 This incongruence was also described by those in forensic services: participants described the restrictions as feeling more salient when they perceived a difference between what they expected and what they lived with. 36…”

“…There was extensive reference to a fear of staff-perpetrated violence during restraint amounting to the use of excessive force or in the use and duration of seclusion. 21, 39, 40, 43, 48, 49, 63, 71, 73, 81, 97, 99, 104, 106–108 It is difficult to establish from the literature any objective threshold whose transgression could be deemed as excessive. However, there was a sense from participants that staff were to be feared and that injury was a likely outcome of restraint.…”

“…Indeed, many participants reported physical injury from restraint. 28, 38, 48, 63, 81, 104 In several studies participants reported that witnessing the restraint or seclusion of peers was a traumatic experience in its own right. 33, 34, 36, 95, 99, 100 Fear, shame and humiliation were visceral reactions to seclusion and restraint.…”

Staff perspectives on the effects of seclusion in adolescent psychiatric inpatient care

“…Furthermore, most adult studies focus on a combination of restrictive/coercive practices (restraint, seclusion, time-out, PRN, etc. ; Krieger et al 2020;Power et al 2020;Scholes et al 2022) even though staff have expressed differences in approval and varied preferences among containment measures (Bowers et al 2007), which suggests differing attitudes to each measure and a need to study seclusion separately.…”

“…2020; Scholes et al . 2022) even though staff have expressed differences in approval and varied preferences among containment measures (Bowers et al . 2007), which suggests differing attitudes to each measure and a need to study seclusion separately.…”