Reducing restrictive practices across health, education and criminal justice settings

In many institutions in the UK, when an adult or child is distressed or agitated, staff may use techniques such as physical restraint and/or being locked in a seclusion room to contain the situation. These ‘restrictive practices’ can be physically harmful and cause psychological trauma. We systematically reviewed interventions to reduce the use of restrictive practices in institutional settings and found the most effective interventions combined techniques from a common pool. Health, education and criminal justice sectors should be encouraged to prioritise evidence backed interventions to prevent harm, reduce associated costs, and improve care

The Rational Regulation of Union Restrictive Practices

Power begets regulation. As union strength grew during recent decades, the federal laissez-faire policy of Norris-LaGuardia and the original Wagner Act gave way to increasingly tighter controls under Taft-Hartley and Landrum-Griffin. Considering the favored position of economic efficiency in our national ethos, it is not surprising that a significant portion of the new controls were directed at union practices which were thought to impede the fullest utilization of employers\u27 productive resources. From time to time, however, thoughtful observers have questioned whether our legal regulation of union activity was properly attuned to the actual needs and economic power of labor and management. Put another way, the problem is that not only does power beget regulation; too often, perhaps, the mere appearance of power begets regulation. I wish I could announce that I am going to supply a definitive blueprint for constructing a rational system for regulating union-restrictive practices - union practices, that is, which limit an employer\u27s freedom in choosing his tools and products, his production techniques, and the persons with whom he will deal. Unhappily, all I can announce is the start, rather than the completion, of a project aimed at shedding some light on the way the law does affect such union restrictive practices, on the way it could affect them and on the way it should affect them. What I would like to share with you is my initial, tentative thinking on the kinds of data we need, and on the use we can make of the information once we have assembled it. I would welcome suggestions on additional questions that should be asked, and opinions on the relevance of this whole inquiry. To keep the discussion within reasonably manageable proportions, I\u27m going to confine my remarks to secondary boycotts, hot-cargo agreements, and the antitrust Implications of union behavior. Obviously, it would be entirely appropriate to deal in addition with jurisdictional disputes and featherbedding. Those topics are omitted simply to avoid a total surrender to diffuseness

An ethnographic study of psychiatric ward life: Exploring experiences of restrictive practices from the perspectives of patients and staff

Inpatient acute mental health services provide care for individuals experiencing a mental health crisis. Restrictive practices such as seclusion, physical restraint and forced medication are often used in this setting however, there is currently a focus within policy to reduce these practices due to the aversive impact they can have on patients and staff. // Part 1 of this thesis is a conceptual introduction which introduces key terms and concepts relevant to the study. It then provides a review of relevant literature exploring experiences of restrictive practices in the inpatient setting, including the environment of the ward; coercion; coercion and the therapeutic relationship; risk management; and positive experiences. The introduction highlights gaps in the literature, including a need for more UK based research and research that allows an inclusion of all practices that are experienced as coercive by patients, rather than focusing solely on the most restrictive of interventions such as seclusion, restraint and forced medication. It also provides a rationale for the study and methodological approach taken. // Part 2 is a qualitative study exploring the experience of restrictive practices from the perspectives of patients and staff situated within an adult inpatient acute mental health hospital. Ethnographic methods were adopted including semi-structured interviews, fieldwork observations and document analysis. Thematic analysis was used to analyse the data gathered. Both patients and staff constructed restrictive practices as rationalised through the need to assess risk and ensure a safe environment. However patients and staff reported negative consequences in relation to the experience of restrictive practices on the ward, whereby both patients and staff experienced a transformation in their subjectivities, with patients feeling treated as ‘prisoners’ and staff feeling viewed of as ‘uncaring’ by patients. Staff were identified as attempting to adopt more humane approaches to reduce the need for restrictive practices, such as methods of de-escalation. However these techniques were experienced by patients as being coercive. Part 2 concludes that further research is required to understand this difference in the experience of de-escalation methods. Clinical and research implications are outlined, including the potential to inform future training programmes, for example through increasing transparency in the way in which staff deliver these interventions. Implications outlined also consider the role in shaping policies regarding the use of these interventions and the reduction of restrictive practices. // Part 3 is a reflective account of the process of undertaking the study that considers the background of the researcher and ethical dilemmas experienced during the data collection as well as reflections on the methodological approaches utilised in the study

Improving mental healthcare

How stigma and over-use of restrictive practices affect the wellbeing of those with severe mental illness

Patients' and staff members' experiences of restrictive practices in acute mental health in-patient settings: systematic review and thematic synthesis

BACKGROUND: Recent guidance has called for the reduction of restrictive practice use owing to growing concerns over the harmful physical and psychological effects for both patients and staff. Despite concerns and efforts, these measures continue to be used regularly to manage challenging behaviour in psychiatric in-patient settings. AIMS: To undertake a systematic review of patients' and staff members' experiences of restrictive practices in acute psychiatric in-patient settings. METHOD: A systematic review and thematic synthesis was conducted using data from 21 qualitative papers identified from a systematic search across three electronic databases (PsycInfo, Embase and MEDLINE) and citation searching. The protocol for the review was pre-registered on PROSPERO (CRD42020176859). The quality of included papers was examined using the Critical Appraisal Skills Programme (CASP). RESULTS: Four overarching themes emerged from the experiences of patients: the psychological effects, staff communication, loss of human rights and making changes. Likewise, the analysis of staff data produced four themes: the need for restrictive practices, the psychological impact, decision-making and making changes. Patient and staff experiences of restrictive practices were overwhelmingly negative, and their use carried harmful physical and psychological consequences. Lack of support following restraint events was a problem for both groups. CONCLUSIONS: Future programmes seeking to improve or reduce restrictive practices should consider the provision of staff training covering behaviour management and de-escalation techniques, offering psychological support to both patients and staff, the importance of effective staff-patient communication and the availability of alternatives

Wages

Empirical analyses of longitudinal data on some 66 manufacturing companies on Britain lead us to the following three conclusions. First, agreed reductions in restrictive work practices lead to increases in productivity. Second, controlling for such agreed reductions, there is some weak evidence that both relative pay and aggregate labour market slack have some positive impact on productivity. Third, falls in market share or declines in the financial health of companies lead to both lower pay rises and reductions in restrictive practices.

Export Cartels and Voluntary Export Restraints Between Trade and Competition Policy

This article discusses the conflicts between trade regulation and competition policy. It begins with a survey of the effect of restrictive practices—particularly those like export cartels that are exempted from competition law regulation—and continues with a critique of national support and authorization for restrictive practices as well as protective state activities, including antidumping rules, rules against unfair trade practices, and voluntary export restraints. The article concludes with a summary of unilateral, bilateral, and multilateral approaches to a more effective international regime for competition policy. It also introduces the recommendation for a Draft International Antitrust Code, which was submitted to GATT

Intuitive Eating and Weight Restrictive Practices among Dietitians in Kuwait

Background Dietitians are healthcare team members responsible for counseling patients with weight concerns. Both traditional/restrictive and intuitive eating/nonrestrictive practices are used with clients seeking weight loss. However, little is known about the weight management practices used with clients by dietitians in Kuwait, which are often related to the dietitians’ knowledge, attitudes, and work experience. Objectives The purpose of this study was to assess the knowledge and attitudes regarding intuitive eating among dietitians dealing with clients for weight management in Kuwait and describe their use of restrictive versus nonrestrictive dietary practices.  Method This was a cross-sectional descriptive study. A self-administered survey was distributed among dietitians working with clients for weight management in public and private clinics. Results In total, 163 participants completed the survey. Most dietitians (81.6%) had not heard of intuitive eating as an independent approach to weight loss and scored low on knowledge of intuitive eating; however, many demonstrated positive attitudes towards intuitive eating (68%). Moreover, dietitians in Kuwait used both restrictive/traditional (69.31%) and nonrestrictive/intuitive eating (79.82%) weight management approaches to counsel clients. Total knowledge was positively correlated with use of nonrestrictive/intuitive eating (r=.259, p=.003) and traditional/restrictive practices (r=.227, p=.009). Years of experience was not related to either practice style. Conclusions Dietitians are combining both restrictive and nonrestrictive approaches for weight management with clients, and their practices are related to knowledge. These findings underscore the importance of continuous education for dietitians working in all sectors in Kuwait

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

An explorative study into the use of restrictive practices in an adult forensic mental health inpatient setting

Reducing or eliminating restrictive practices (specifically seclusion, restraint, and Pro Re Nata [PRN] psychotropic medications), is a global health priority due to the risk of patient harm, workforce stress, injury, and human rights issues. The aim of this research was to explore the use of restrictive practices in the acute forensic mental health inpatient setting (AFMHIS). A multiphase mixed method research design (QUAN-qual) was used, with three quantitative and one qualitative research studies conducted in an AFMHIS in Australia. The use of a mixed methods research design facilitated a comprehensive exploration of a complex phenomenon from multiple perspectives and offered unique insights which can inform practice and policy development