Wilson et al-2017-International Journal of Mental Health Nursing
The 2017 International Journal of Mental Health Nursing article reports a qualitative study exploring how adult mental health in‑patients and staff experience physical restraint on NHS inpatient wards in Cambridgeshire and Peterborough. Semi‑structured one‑to‑one interviews were conducted with 13 patients (including witnesses) and 22 staff members (including managers, nurses, therapists and support staff). Thematic analysis identified an overarching theme – “Is restraint a necessary evil?” – with two contrasting sub‑themes. The first, “It never is very nice,” captures predominantly negative emotional and relational outcomes: distress, fear, dehumanisation, loss of control, reduced job satisfaction and damage to therapeutic relationships. The second, “It’s a necessary evil,” reflects participants’ view that restraint can be justified as a last‑resort safety measure protecting patients, staff and property, though opinions diverge on whether it is always used only after all alternatives have failed. Communication and de‑escalation were highlighted as pivotal in preventing unnecessary restraint. The discussion situates these findings within existing UK and international literature, acknowledges limitations (e.g., exclusion of specialist wards, reliance on retrospective recall), and stresses the tension between political pressure to reduce restraint and the perceived need for safety. The authors conclude that while restraint is experienced as overwhelmingly negative, it is still seen as a necessary evil; they call for further research on alternatives, staff and patient support, and for training tools that convey the emotional and relational costs of restraint to aid reduction efforts.
Topics
Restraint as a ‘necessary evil’: The central paradox
The overarching theme that frames the whole study – restraint is simultaneously condemned for its harms yet defended as an unavoidable safety tool.