Strategies to minimise Restrictive Practices in Acute Inpatient Services: A qualitative study

Introduction: Restrictive practices are interventions – typically physical and mechanical restraint and seclusion – applied in inpatient mental health services intended to regulate client’s behaviour. People who use inpatient mental health services have reported that restrictive practices are traumatic and hinder recovery.

The aim of this study was to develop an understanding of how restrictive practices can be reduced. Consequently, this research projects investigates the approach being taken by an Australian service with some of the lowest rates of restrictive practices, to identify factors to support these efforts.

Methods: This qualitative study involved interviews with people that had been an inpatient within 3 months of recruitment, their supporters, and care staff. Fieldwork was conducted by a lived experience researcher in a single mental health service in Melbourne, Australia with 50 inpatient beds. Transcribed interviews were thematically analysed.

Results: Forty-two people participated in the study. The key theme is: “person centred care appeared to minimise the application of restrictive practices.” Participants spoke of top-down leadership directives that discouraged the use of restrictive practices, instead championing prevention methods such as interpersonal connections between staff and clients and use of PRN (pro re nata).

Discussion: The key finding from this study was that staff responsiveness to the needs of clients supports reduction in the use of restrictive practices. Our results are consistent with previous studies that have examined factors impacting the application of restrictive practices reported over many decades. Despite a clear set of approaches already documented in the literature mental health practice, there seems to be little indication that front line practice reflects this decades long accumulation of knowledge.

Conclusion: Rigorous application of approaches that are demonstrated to be effective can substantially reduce the need for interventions that are both distressing and potentially traumatising.