Service users' experiences of restrictive practices in adult inpatient mental health services. A systematic review and meta-ethnography of qualitative studies.

Background: There is a focus globally on reducing restrictive practices in mental healthcare. However, we know little about how service users experience restrictive practices generally.

Aim: To explore and synthesise experiences of restrictive practices in adult inpatients mental health settings and to report on the depth and breadth of the literature. Methods. CINAHL, PsycINFO, Scopus, MEDLINE and Embase were searched. Qualitative studies exploring the service user experience of restrictive practices were included and analysed using meta-ethnographic synthesis.

Results: Twenty-seven papers were included. Restrictive practices are experienced negatively by service users, who feel punished and powerless when the therapeutic relationship is weak, and communication is lacking. The third-order constructs were: (1) anti-therapeutic and dehumanising, (2) a vicious cycle, (3) an abuse of power and (4) the critical role of support and communication (subthemes: (i) the impact of communication and (ii) how support and communication can minimise negative impacts).

Conclusions: Participants suggest that increasing supportive communication and detailing the decision making for using restrictive practices, would reduce feelings of coercion and increase trust in staff. Future research into the experience of restrictive practice should aim to capture the experience of informal restrictive practices such as locked doors and coercive language.

Prsima/prospero statement: The review has been conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; see Supplemental Materials Table S1) and the Meta-Ethnography Reporting Guidelines (eMERGE; see Supplemental Materials Table S2). The protocol was registered on PROSPERO (registration number: CRD42023399272; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023399272).