Protest or Illness. A PhD study of patients' and relatives' perceptions of situations associated with mechanical restraint in forensic psychiatr

Background: There is an increasing focus on the reduction of coercive measures, especially mechanical restraint (MR), in psychiatric settings. Knowledge of patients’ and relatives’ perceptions of coercive measures, and the involvement of this knowledge in clinical practice, is crucial to reduce their use and improve evidence-based patient care. However, patients and relatives’ perceptions of MR episodes specifically within a forensic setting, have not been addressed in earlier studies.
Objective: To generate knowledge about the meaning forensic psychiatric patients and relatives ascribe to perceptions of situations before, during and after MR episodes, and to develop knowledge about what they perceive
can impact and reduce MR episodes.
Method: The Ph.D. study comprised a qualitative research design, in which the methodological requirements of Symbolic Interactionism (Blumer 1986) were utilized to conduct a systematic literature review of 26 studies and indepth, semi-structured interviews with 20 forensic psychiatric patients and 15 relatives of forensic psychiatric patients.
Results: Patients’ and relatives’ perceptions of MR episodes can be viewed as a process that starts before, continues during, and ends after MR episodes. However, the process of MR, and thus the situations that occur throughout this process, were perceived differently, depending on the main cause of MR episodes: In the case of the process of MR in regard to the patients’ ‘overt protest reactions’, patients and relatives ascribed meaning to MR
episodes as a result of staff’s lack of care, protection and professionalism. Opposite, and in the case of the process of MR in regard to the patients’ ‘illness-related behaviour’, patients and relatives ascribed meaning to MR episodes
as a result of staff’s provision of care, protection and professionalism.
Conclusion: Based on the results, de-escalation, inclusion and involvement of relatives, debriefing, and caring attitudes from staff, is suggested to reduce the use and duration of MR episodes.