Least restrictive practices: an evaluation of patient experiences

The uses of restrictive practices have become increasingly controversial over recent decades. With an increasing emphasis in recovery orientated values and person centred care, the uses of restrictive practices have become ever more contentious. National and international policies and guidelines have called for a reduction in the uses of these practices and interventions, and emphases on ‘least restrictive practices’ have been outlined. The notion of ‘least restrictive practices’ however, is not clearly defined. Limited research has been conducted to examine the uses of restrictive practices specifically within forensic mental health services. Little is known with regards how patients perceive and experience restrictive practices within high security hospital settings. It is therefore timely to consider patient experiences of restrictive practices and interventions, specifically within the context of a forensic high security mental health hospital. This study aims to explore patients’ experiences of restrictive practices and interventions within Rampton High Security Hospital.Twenty eight interviews were conducted, with nineteen male and nine female patients. The interviews were conducted using a narrative inquiry approach in seeking the personal experiences of patients, and towards gaining a better understanding of the complexities surrounding least restrictive practices within a high security hospital context. Findings from the interviews revealed three core themes; i) patient experiences of the high security hospital environment; ii) experiences of restrictive practices and interventions, and iii) working towards overcoming trauma and adversity. Patient experiences of the high security hospital environment were narrated in terms of learning the rules of the hospital. Patient experiences of restrictive practices were spoken of both in terms of their personal involvement as well as observation of others; each of which were perceived to be traumatising and re-traumatising. Restrictive interventions were frequently perceived as punitive; either actually or inadvertently, and were described in terms of fear, anxiety and loss of dignity. In working towards overcoming trauma, patients spoke of the importance of humanity, occupation and the maintenance of relationships outside of the hospital. Findings of this report therefore highlight the importance of: i) building trust and supporting patients into this new and unfamiliar environment; ii) the maintenance of identity and relationships, and iii) being treated with dignity and humanity in overcoming past and present traumas that may be associated with experiencing restrictive practices with a high security hospital environment