The consequences can be devastating. Restrictive practices are associated with trauma, worsening mental health, and even death. For decades, clinicians, researchers and policymakers have called for their reduction. Progress, however, remains painfully slow.<\/p>\n
For the past five years, I have been researching<\/a> the use of restrictive practices in mental health services and exploring how to reduce them. My new research<\/a> demonstrates the importance of using compassion to support staff to promote the dignity and wellbeing of patients as a priority.<\/p>\n Restrictive practices have a long history that predates<\/a> the development of asylums and psychiatry as a medical discipline. The use of legislation to detain people on the basis of their mental health in England, for example, dates back to at least the 14th century. Early examples of restrictive practices included patients being bound and beaten with rods in order to \u201crestore sanity\u201d.<\/p>\n During the first three decades of the 19th century, mechanical restraints such as straitjackets, chains and restraint chairs and confining patients in locked rooms were widely accepted methods of controlling violent people in British asylums. But in the 1830s<\/a>, some clinicians recognised the moral and ethical problems with using such practices, and a campaign began to abolish them. <\/p>\n The UN has long recognised restrictive practices in mental healthcare as a human rights issue. In 2008, the UN\u2019s special rapporteur on torture stated<\/a> that methods such as solitary confinement violate articles 14 and 15<\/a> of the Convention on the Rights of Persons with Disabilities, which protect against arbitrary detention and cruel, inhuman or degrading treatment. <\/p>\n This stance was reaffirmed in 2021 when the UN declared<\/a> that restrictive practices breach the fundamental rights of patients. This underscores the urgent need for reform in mental healthcare systems worldwide.<\/p>\n Harmful effect<\/p>\n Research shows<\/a> that restrictive practices may not only harm patients but contradict the goals of mental healthcare. Many mental health problems stem from<\/a> traumatic experiences that leave people feeling powerless, unsafe and distressed. Using methods that reinforce these feelings can worsen the very issues services aim to address.<\/p>\n In extreme incidents, people have died<\/a> as a result of restrictive practices use. <\/p>\n In my research, I have developed a theoretical model<\/a> identifying core factors that perpetuate the use of restrictive practices in mental health services. These include the emotional challenges faced by staff working in high-stress environments, and how these challenges influence their decision-making.<\/p>\n Mental health wards can be highly stressful environments, with frequent incidents of aggression. In such settings, staff can often feel anxious and hyper-vigilant, which can make it harder for them to respond to patients with compassion<\/a>.<\/p>\n
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