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.