Relatives and Carers’ Perspectives on Restrictive Practice in Inpatient Settings for People with Psychosis Diagnoses

Background: Restrictive practice is a common occurrence in inpatient mental health settings, despite policy shifts towards less restrictive approaches. Carers play a significant role in acute mental healthcare yet are often left out of both clinical conversations and research. There is emerging but limited qualitative exploration of carers’ perspectives on inpatient restrictive practice in the UK context. Further, research in the area typically does not distinguish between acute mental health presentations, despite some evidence suggesting that restrictive practice may be experienced differently by those with psychosis.

Aim: The present study therefore aimed to explore the experiences and perspectives of carers of people with psychosis regarding the use of restrictive practice in inpatient settings.

Methods: Eight semi-structured interviews were conducted with carers of a loved one with a psychosis-related diagnosis. Data was analysed via reflexive thematic analysis.

Results: Five themes were constructed, each with two to three sub-themes. Themes included: ‘System-wide impacts’; ‘Restrictive practice and psychosis’; ‘Negative operations of power’; ‘A need for dialogue’; and ‘Prospects for system change’.

Implications: The results were discussed in relation to the previous literature on staff, service user, and carer perspectives, showing some agreement between the three groups. Novel findings were discussed, including exploration of the complex relationship between psychosis and restrictive practice, which offered an argument that this may be fundamentally different to those with other mental health difficulties. The findings highlighted the value of carers’ insights in shaping care and potentially reducing the need for restrictive interventions, and took a systemic lens to understanding restrictive practice in terms of its impacts not only on those directly involved but throughout wider networks. Implications for research, clinical practice, policy and service development are considered.