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

The use of coercive measures in a high secure hospital: expressions of institutional and emotional work

This thesis examines the use and implications of using coercive measures within a high security hospital. High security hospitals are unique environments where challenges are often faced in balancing care with safety and security. The use of coercive measures, namely, restraint, seclusion, rapid tranquillisation and segregation, are considered unavoidable necessities in preventing and/or limiting harm. Yet coercive measures are deemed ethically, morally and professionally controversial. This study explores patient, staff and environmental factors that influence variations in attitudes and experiences towards the use of coercive measures using a sequential mixed methods design. Stage one examines the rates, frequencies and demographic characteristics of patients experiencing coercive measures. . Stage two uses standardised questionnaires to elicit and analyse staff and patient attitudes towards aggression (ATAS), containment measures (ACMQ) and hospital environment (EssenCES). Stage three uses a constructivist grounded theory approach to conducting semi-structured interviews with staff using institutional and emotional work theories. Findings revealed that younger, newly admitted females were those most likely to experience coercion. Aggression was viewed as being significantly more destructive on the pre-discharge ward, in comparison with the admission, ICU and treatment ward. Discrepancies were found between staff and patient perceptions of the least acceptable containment measures. Patients experienced the hospital environment as more supportive and cohesive than staff. Finally, findings from the staff interviews uncovered a complex interplay between personal and institutional expectations, values and actions. Further research is required into examining i) the attitudes and implications regarding the least restrictive methods, ii) the internal dynamics within high secure hospitals warrant and what it means for staff to be working in an environment where patients feel more supported by being contained than staff do when containing them, and iii) what can be done to relieve the tensions of healthcare professionals expected to care, coerce and contain

The lived experiences of Black and Minority Ethnic patients within a high security hospital

Black and minority ethnic (BME) communities are disproportionately overrepresented in mental health and legal systems within the UK. People from BME communities are detained more frequently, receive poorer mental health care, and are restrained and secluded more often than individuals from non-BME backgrounds. High security hospitals represent the physical spaces in which mental health and legal disciplines merge, thereby offering unique contexts for study. Ten narrative interviews were conducted with individuals who identified themselves as being of BME backgrounds within a high security hospital. These aimed to i) explore the experiences of BME individuals accommodated within a high security hospital; ii) investigate BME individuals’ experiences of coercion and restrictive practices, including security, restraint, seclusion and segregation; and iii) identify themes that promote health outcomes for BME individuals in this context. Data was analysed using an iterative-inductive approach, allowing for the emergence of themes from the data, and for links to be made between findings, theories, policies and practice. Three themes emerged from the findings: i) turbulent journeys; ii) discovering stability; and iii) freedom, hope and aspirations. Turbulent journeys related to the challenges of seeking help and support, and of experiencing oppression, hopelessness, fear and mistrust. Discovery of stability had subthemes rooted in breaking the vicious cycles of detention and discharge, of working with rather than against the system, and of developing individual roles, identities and forms of self-expression. Freedom, hope and aspirations captured the importance of relationships, occupation, health and wellbeing. Based on these findings, this report recommends that: i) BME individuals must have equal access to mental health care, and fair treatment within mental health and legal services, to improve their experiences of health, care and wellbeing; ii) guidance mist be revised, developed and implemented to ensure that restrictions within secure hospitals do not impinge upon individuals’ expressions of self, identity and culture; and iii) it is imperative that restrictive practices, for example, restraint, seclusion and segregation, do not inadvertently become forms of structural violence by perpetuating the fear and violence they set out to contain. These are each paramount to improve the health and wellbeing of BME individuals

The use of coercive measures in a high secure hospital: expressions of institutional and emotional work

This thesis examines the use and implications of using coercive measures within a high security hospital. High security hospitals are unique environments where challenges are often faced in balancing care with safety and security. The use of coercive measures, namely, restraint, seclusion, rapid tranquillisation and segregation, are considered unavoidable necessities in preventing and/or limiting harm. Yet coercive measures are deemed ethically, morally and professionally controversial. This study explores patient, staff and environmental factors that influence variations in attitudes and experiences towards the use of coercive measures using a sequential mixed methods design. Stage one examines the rates, frequencies and demographic characteristics of patients experiencing coercive measures. . Stage two uses standardised questionnaires to elicit and analyse staff and patient attitudes towards aggression (ATAS), containment measures (ACMQ) and hospital environment (EssenCES). Stage three uses a constructivist grounded theory approach to conducting semi-structured interviews with staff using institutional and emotional work theories. Findings revealed that younger, newly admitted females were those most likely to experience coercion. Aggression was viewed as being significantly more destructive on the pre-discharge ward, in comparison with the admission, ICU and treatment ward. Discrepancies were found between staff and patient perceptions of the least acceptable containment measures. Patients experienced the hospital environment as more supportive and cohesive than staff. Finally, findings from the staff interviews uncovered a complex interplay between personal and institutional expectations, values and actions. Further research is required into examining i) the attitudes and implications regarding the least restrictive methods, ii) the internal dynamics within high secure hospitals warrant and what it means for staff to be working in an environment where patients feel more supported by being contained than staff do when containing them, and iii) what can be done to relieve the tensions of healthcare professionals expected to care, coerce and contain

Profiling Interactive Television Research: A Bibliometric Review

Though the recent revolution in digital processing ushers the broadcasting industry into a new era, the interactive television (iTV) has been regarded as the third generation of broadcasting services and relevant issues of iTV have gained tremendous interests from both academics and practitioners. This article endeavours to profile the scholarly development of the interactive television literatures by utilizing bibliometric technique to review the literature material in SCIE, SSCI, and A&HCI databases appeared in 1970 to 2009. There are 228 documents in total. The analysis is conducted on such as most productive authors, authors’ background, geographic diversity analysis (including countries and institutions), subject areas, publication year, and the citation analysis. The conclusions about the promising future, research direction, and the attribute of interactive television research are derived from this study

Ethnic mental health inequalities and mental health policies in England 1999-2020

Background: Despite many policy initiatives in the last two decades, ethnic mental health inequalities have persisted in England. Aim & method: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. We specifically focus on ethnicity-related mental health issues highlighted in policies, policy recommendations and performance measurements of policy implementation. Findings: Findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the last two decades. Ongoing issues include a lack of data on the ethnicity of mental health services users. Where data is available, these highlight ethnic inequalities in access to, experiences of, and outcomes of mental health services, as well as a lack of cultural capability in healthcare professionals. Policy recommendations have also remained the same during this time, and include: collecting data on the ethnicity of service users, raising awareness of the cultural needs of Black and Minority Ethnic (BME) populations amongst healthcare professionals, recruiting BME staff into mental healthcare services and improving community engagement. The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes.Policy/practice implications: The synthesis discusses the challenges of policy implementation using literature from the field of organizational behaviour

Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: illustrative cases from the UK healthcare system

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon the national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways