The use of physical intervention in acute mental healthcare: decision-making and rationalisation among healthcare staff.

Prosser, H

Abstract

Physical intervention (PI) is “a skilled hands-on method of physical restraint involving trained designated healthcare professionals (aiming) to prevent individuals from harming themselves, endangering others or seriously compromising the therapeutic environment” (NICE, 2005). Although intended as a protective strategy, its use is controversial. It has both physical and psychological outcomes for service users and is increasingly seen as incompatible with claims of best practice and values of respect, dignity and autonomy. It is distressing for service users and usually experienced by them as abusive. Moreover, the use of restraint in a horizontal position has led to fatalities in acute mental health services. As such, its use can generate significant ethical conflict for mental healthcare staff.

This paper brings a sociological perspective to our understanding of the reasons why, and the circumstances in which, PI is used, in order to reflect on, and potentially improve, organisational practice. Staff from an acute mental health unit were recruited to the study following involvement in a PI incident. The meanings of PI and how staff account for its use were explored through semi-structured interviews and focus group discussions. Discursive accounts of PI reveal 5 interrelated themes through which decision-making is constructed and PI rationalized: specifics of service user behaviour; routinisation; control; risk/uncertainty; ideologies and values. Accounts also reveal the ambivalent constructs of PI as a protective device and as a strategy for management and control. Implications for practice, organisational change and staff training on managing violence and aggression are discussed.

Citation

Prosser, H. The use of physical intervention in acute mental healthcare: decision-making and rationalisation among healthcare staff. Presented at BSA Medical Sociology Group 41st Annual Conference, 3-5 September 2009

• Presentation Conference Type: Other
• Conference Name: BSA Medical Sociology Group 41st Annual Conference
• Conference Location: 3-5 September 2009
• Publication Date: Sep 1, 2009
• Deposit Date: Sep 7, 2011
• Publicly Available Date: Sep 7, 2011
• Additional Information: Event Type : Conference