Abstract
Physical restraint is regularly used in children and adolescent mental health care, often as a reactive behaviour management strategy. Physical restraint has been associated with physical injury, but psychological consequences are poorly understood. The aim of this systematic review was to examine physical restraint of children and adolescents in inpatient mental healthcare services. Healthcare databases were searched to identify English language publications discussing anyone aged ≤18 years who had experienced physical restraint as a mental health inpatient. No date restrictions were applied. Sixteen quantitative studies are included within this review. Most studies are retrospective in nature. Publications were appraised using the Critical Appraisal Skills Programme quality assessment tool. Common characteristics associated with children and adolescents who experience physical restraint include age, gender, diagnosis, and history. Most studies associate physical restraint with the management of aggression. Findings suggest that it may be a combination of patient (intrinsic) and environmental (extrinsic) factors which ultimately lead to children and adolescents experiencing restraint. This review confirms that little is known about children and adolescents’ first-hand experiences of physical restraint. Future research should address children and adolescents’ perceptions and first-hand experiences of physical restraint.
Highlights
Restrictive interventions, which include restraint, have a long history within mental healthcare services
The aim of this review was to systematically locate, appraise, analyse, and synthesise literature pertaining to the physical restraint of children and adolescents in inpatient mental healthcare services
All included studies were quantitative in nature, reflecting the paucity of empirical qualitative research in the current literature reporting on the physical restraint of children and adolescents in mental health care
Summary
Restrictive interventions, which include restraint, have a long history within mental healthcare services. Despite the potential risk of physical injury as a result of being physically restrained (Department of Health, 2014), its implementation in mental healthcare practice is sometimes deemed necessary to maintain safety (Wilson et al, 2015) and protect children and adolescents and/or people around them from harm (National Institute for Health and Care Excellence, 2017). In the United Kingdom, ‘...physical interventions should only ever be used as a last resort...’ (Department of Health, 2014: 9) and broad guidelines, targeted at health, social care, and educational providers, as well as local authorities and clinical commissioning groups, aim to eliminate the inappropriate use of physical restraint with children and adolescents who are ‘...still developing both physically and emotionally and for whom trauma...could be very damaging...’ (Department of Health, 2017: 5). Not all healthcare guidelines have provided evidence-based frameworks of how to implement standards (Wilson et al, 2015)
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