Co-Designing Case Scenarios and Survey Strategies to Examine the Classification and Reporting of Restrictive Care Practices in Adult Mental Health Inpatient Settings: Perspectives From International Stakeholders.

There is a global initiative to reduce the use of restrictive care practices in mental health settings. Variations in the reported rates across regions complicate the understanding of their use and tracking trends over time. However, it remains unclear whether these discrepancies reflect real differences in the implementation of these practices or are sourced from inconsistencies in incident classification and reporting methods. This study employed a co-design approach to identify contexts that would influence the classification and reporting of restrictive care practices. The research involved 29 mental health stakeholders, including 22 professional experts from 13 countries across Europe, Africa, North America, Asia and Australasia and seven service users and family carers from Australia. Recruitment was conducted through email invitations, snowball sampling and social media outreach. Six web-based panel meetings, each lasting 90-120 minnutes were held. These discussions focused on exploring various contexts that might lead to uncertainty among professionals when classifying and reporting actions whether or not as restrictive care practices. A final list of 23 contexts was identified and considered for the development of 81 case scenario items. Finally, all the 29 panel members selected 44 from 81 case scenarios for inclusion in an upcoming international survey to examine variations in the classification and reporting of restrictive care practices. The findings from this co-design work emphasise the involvement of a wide range of factors and contexts in the classification and reporting of restrictive care practices that may contribute to the observed variations in the in the reported rates of these practices. The case scenarios developed in this study will support future research and serve educational purposes, illustrating real-life situations in the mental healthcare context.