Abstract

Restrictive practices are often harmful and many academics, policy-makers and clinicians agree that their use should be reduced in care settings. Specific focus on secure mental health services is warranted because restrictive practices are often seen as an integral part of forensic psychiatry but have received limited research attention relative to other areas of psychiatric practice. The aim of this scoping review was to map and evaluate recent empirical research that examines the use of restrictive practices, the consequences of using them and efforts to reduce restrictive practices, in secure mental health settings published since June 2015. The purpose of this review was to identify limitations and gaps in the literature in order to inform further research. PsycINFO, Medline, Embase, CINAHL, Scopus and ASSIA databases were searched for studies published between 2015 and 2020. Following electronic and manual searches, 36 studies were included. The studies were grouped into four main areas: 1) Nature of the problem describing the type, incidence, prevalence and scope of restrictive practices in secure mental health services; 2) Service user perceptions and experiences of restrictive practices; 3) Staff experiences, views and decision making; and 4) Interventions designed to reduce the use of restrictive practices. Findings support the notion that restrictive practices have a detrimental impact on the wellbeing of most service users in adult secure services as well as the staff who use them. Continued efforts to reduce restrictive practices are needed and the importance of collaborative working cannot be understated. Implications for future research, clinical practice, policy and best practice guidelines are all discussed.

摘要

限制性做法通常是有害的，许多学者、政策制定者和临床医生都认为应该减少在护理环境中的使用。有必要特别关注安全的心理健康服务，因为限制性实践通常被视为法医精神病学的一个组成部分，但相对于其他精神病学实践领域，受到的研究关注有限。本次范围审查的目的是绘制和评估最近的实证研究，这些研究检查了自 2015 年 6 月以来在安全的心理健康环境中使用限制性做法、使用这些做法的后果以及减少限制性做法的努力。本次审查的目的是找出文献中的局限性和差距，以便为进一步的研究提供信息。PsycINFO、Medline、Embase、CINAHL、Scopus 和 ASSIA 数据库搜索了 2015 年至 2020 年间发表的研究。在电子和手动搜索之后，纳入了 36 项研究。这些研究分为四个主要领域： 1) 描述安全精神卫生服务中限制性做法的类型、发生率、流行和范围的问题的性质；2) 服务用户对限制性做法的认知和体验；3) 员工的经验、观点和决策；4) 旨在减少使用限制性做法的干预措施。调查结果支持这样一种观点，即限制性做法对成人安全服务中的大多数服务用户以及使用这些服务的员工的福祉产生不利影响。需要继续努力减少限制性做法，并且不能低估协作工作的重要性。