Research from university of Lancashire into the use of Physical Restraint
Digital team's blog
Even though the Mental Health Act Code of Practice says restraint should only be used ‘when in the best interests of the individual’, recent research carried out by Agenda found that 14,000 people were physically restrained in the UK between 2014 and 2015. In this special blog as part of our mental health act series, we speak to Pauline, a researcher from the university of Lancashire about why this issue matters and how our supporters can share their experiences and shape a better mental health act.
Hi Pauline, could you tell us a bit about what you hope to find out by doing this research project?
I am hoping to find out about people’s experiences of being physically restrained in the past 12 months and gain a patient perspective about how and why physical restraint has been used. I am interested in what impact this has had on patients before, during and after the physical restraint.
What do you mean by physical restraint?
I am specifically looking at when this occurs on mental health wards and when used by nursing staff. It has been defined as physically holding a patient to prevent or restrict movement . There is significant concern about the potential harm to individuals caused by physical restraint, with some examples of poor practice. It has the potential to cause both physical and psychological harm. There are particular concerns about physical restraint being used when an individual is placed face-down on a surface and is physically prevented from moving from this position, which can cause breathing difficulties and can be life threatening.
Physical restraint should only be used as a last resort, or in an emergency when serious risks to the person or others is present. Engagement with patients as active partners in their care is the cornerstone of good practice and may reduce restraint related incidents. For staff working on mental health wards this means getting to know the person and to establish the best way to prevent conflict. Prevention and de-escalation of potential conflict should be the first response in order to minimise the use of restrictive interventions.
Why is this an important issue?
Physical restraint is undertaken by staff to prevent imminent harm to the patient or others. There is Guidance by the Department of Health in 2014 , which sets the policy in the UK to minimise interventions such as this.
There have been some national scandals around the misuse of physical restraint and the Care Quality Commission this year has reported remaining concerns about its use, particularly when patients have been restrained face down. The system could be improved by the promotion of positive interpersonal interaction between staff and patients, and through good communication, which recognises the benefits of engaging in therapeutic relationships. Wards should be comfortable and provide a safe sanctuary. Staffing on wards should be adequately and appropriately resourced. Patients should be actively involved in their risk assessments and care plans. Clear organisational policies reflecting an individual’s human rights and their dignity is essential. It is important to focus on physical restraint to ensure that individuals are treated safely, humanely and in a dignified manner. This work is important as the perceptions and experiences of individuals who have experienced restraint provides valuable insights and an in-depth understanding of this issue. It therefore enables the quality of in-patient care to be improved.
What is the process involved in this research project?
I have already done a lot of reading about physical restraint and have written this up. I have also gained ethical approval to make sure that my research is done properly and within the right guidelines. The next part of the process is to ask people who have been physically restrained by staff, if they want to be involved in my research. This would involve people telling their story and me listening to them. This will be in the form of a one to one meeting, either in person, by Skype or over the phone. People who have told their stories would remain anonymous. Involvement is voluntary, so I would gain consent to be involved, from people who have expressed an interest in being involved.
Normally such research interviews are recorded and I would transcribe what was said and then look at this in more detail. I plan to interview around 8-10 people, so that I can see a collection of stories. Ideally, different people will have had a range of different experiences and be able to tell me about these. From this point, I would write up what I have found as part of my thesis and also look at publishing an article in a journal and attend conferences to speak about my research.
What is it like being a researcher?
It is exciting and at times can be challenging. I have read a lot around physical restraint use and this has meant many hours looking through other studies. You need to be really interested in the area of your study, and this motivates researchers to find out more. I often describe myself as ‘an anorak’, and although I have found a lot out, I still want to know more, particularly as there is no research about stories from a patient’s perspective.
If you are interested in being involved in this research, you can contact Pauline via email. You might also be interested in reading our joint briefing with Agenda on Steve Reed’s Mental Health Units (Use of Force) Bill here. To follow progress on the Mental Health Units (Use of Force) Bill and get latest updates click here.