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In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio-narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's ‘quest narrative’. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238].

During the past thirty years, there has been increasing concern regarding physical restraint and its association with death, injury, pain and emotional upset. Internationally there has been a shift to reduce the use of all forms of restraint. Policy and guidance in the United Kingdom, for health and social care staff, advises a preventative and de-escalatory approach in managing service user aggression and violence. If restrictive interventions are deemed necessary, these should be used for the shortest time possible, with staff using the least restrictive means to meet the immediate presenting need and physical restraint reserved for only when absolutely necessary. Yet disparities in the use of restraint remain, questioning this professional rhetoric of last resort. This thesis reports on a study exploring the narratives of service users who have experienced physical restraint. This qualitative study collected data from interviews with 11 service users who have experienced physical restraint. Stories were analysed using Frank's (2010) guiding questions for analysis and his suggestion for focused attention on a selection of stories. In keeping with this approach four stories are presented, three involving a quest narrative; Rory: a story of a resistance; Jane: a story of injustice; Rose: a story of trauma; and one a restitution narrative; Finlay: A story of saving life. While each story is unique, there are also similarities across all stories. Consideration was given to the inter-relationship with other stories told about mental health service users and some of the grander narratives which underpin care practices or are influential within society. In this sense, individual stories were considered in the context of the narrative inter-relationships between all of the stories which acts to construct our knowledge of the world and even our sense of who we are. The powerful narratives of neoliberalism and biomedicine, in particular, are considered for their potential i

In Western society, policy and legislation seeks to minimize restrictive interventions, including physical restraint; yet research suggests the use of such practices continues to raise concerns. Whilst international agreement has sought to define physical restraint, diversity in the way in which countries use restraint remains disparate. Research to date has reported on statistics regarding restraint, how and why it is used, and staff and service user perspectives about its use. However, there is limited evidence directly exploring the physical and psychological harm restraint may cause to people being cared for within mental health inpatient settings. This study reports on an integrative review of the literature exploring available evidence regarding the physical and psychological impact of restraint. The review included both experimental and nonexperimental research papers, using Cooper's (1998) five‐stage approach to synthesize the findings. Eight themes emerged: Trauma/retraumatization; Distress; Fear; Feeling ignored; Control; Power; Calm; and Dehumanizing conditions. In conclusion, whilst further research is required regarding the physical and psychological implications of physical restraint in mental health settings, mental health nurses are in a prime position to use their skills and knowledge to address the issues identified to eradicate the use of restraint and better meet the needs of those experiencing mental illness.

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman or degrading treatment, and having the right to liberty, security, respect and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature findings revealed restraint can be a form of abuse, it’s inappropriate use often being a consequence of fear, neglect and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike.