An Initial Investigation into Mental Health Clinicians' Aims to Reduce Restrictive Practices

Abstract

Purpose: Internationally, service users and their families have raised concerns about safety in current mental health service delivery. Underfunding and risk-averse management practices are implicated as key challenges. This study aimed to explore initial clinician perspectives on needed changes to reduce restrictive interventions and to improve conditions for service users and staff alike. Materials and methods: Utilizing a co-operative inquiry approach, this unique study was clinician-led and co-produced by researchers and clinicians. Community and Emergency Department Crisis Mental Health Clinicians (from both nursing and social work backgrounds) explored their use of restrictive interventions, and what they need from policy and resources to change practices. Clinician-researchers collected data across two meetings, subsequently co-conducted a thematic analysis of their reflections in a group setting, and co-produced the write up and reflections of the results. Results: Seven themes were developed which explored: the holding of risk; over interventions, imperfect solutions; containment seeking; time’s importance in the holding of risk; least restrictive environments; and holding risk as an isolating practice. These themes are presented as questions that arose through these discussions, as clinician-researchers reflected on their own practice. Discussion: The environments where crisis clinicians work are not designed for least restrictive practice, despite these clinicians often find creative and thoughtful solutions to imperfect circumstances. Conclusion: This study models and encourages deep dialogue toward redesigned policy and practices and for future research.