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Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use. With federal impetus and funding, an evidence-based practice, the Six Core Strategies to Prevent Conflict, Violence and the Use of Seclusion and Restraint, was developed. This model was widely and successfully implemented in a number of U.S. states and is being adopted by other countries, including Finland, Australia, and the United Kingdom. Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology. Preliminary findings of some of the international efforts are discussed. Reduction in R/S use and other positive outcomes are also reported., (Copyright 2014, SLACK Incorporated.)

Accessible summary: What is known about the subject?: People experiencing mental distress have a high rate of contact with police in community crisis events.Police use a continuum of responses when managing situations involving agitation, aggression and behavioural problems.People experiencing mental distress have been subjected to Tasers as part of the police response.Following a number of deaths and numerous reports of injuries, concerns have been raised about the safety of Tasers. What this paper adds?: Police use of Tasers in mental health crises is relatively common.Tasers are used in a range of settings including public places, private residences and healthcare facilities.People experiencing mental distress may be subjected to more use of Tasers than the general population. What are the implications for practice?: Mental health professionals need to work with police towards greater understanding of the needs of people experiencing mental distress and to promote the use of non‐coercive interventions in mental health crisis events.Mental health researchers need to explore the qualitative experiences of people who are Tasered, to provide an evidence base for Taser use with people experiencing mental distress. Introduction: Conducted electrical weapons, or "Tasers," are currently used by over 15,000 law enforcement and military agencies worldwide. There are concerns regarding the effectiveness, potential for harm and overuse with people experiencing mental distress. Aim: To explore the literature about police use of Tasers with people experiencing mental distress. Method: An integrative review was undertaken, and qualitative and quantitative analytical approaches were used. Results: Thirty‐one studies were included. Of all recorded usage, overall prevalence of Taser use on people experiencing mental distress was 28%. This population appears to experience higher Taser usage than the general population. Discussion: There are substantial gaps in the research literature particularly with respect to the decision‐making processes involved in deploying Tasers on this population and the physical and psychological consequences of Taser use in this context. Implications for practice: Police use of Tasers in mental health crises is relatively common and occurs in a variety of environments including mental health settings. Mental health professionals need to work with police towards greater understanding of the needs of people with mental illness and to promote the use of non‐coercive interventions in mental health crisis events. [ABSTRACT FROM AUTHOR]

Coercive practices, such as physical restraint, are used globally to respond to violent, aggressive and other behaviours displayed by mental health service users.1 A number of approaches have been designed to aid staff working within services to minimise the use of restraint and other restrictive practices. One such approach, the 'REsTRAIN Yourself' (RYS) initiative, has been evaluated in the UK. Rapid ethnography was used to explore the aspects of organisational culture and staff behaviour exhibited by teams of staff working within 14 acute admission mental health wards in the North West region of the English NHS. Findings comprise four core themes of space and place; legitimation; meaningful activity; and, therapeutic engagement that represent characteristics of daily life on the wards before and after implementation of the RYS intervention. Tensions between staff commitments to therapeutic relations and constraining factors were revealed in demarcations of ward space and limitations on availability of meaningful activities. The physical, relational and discursive means by which ward spaces are segregated prompts attention to the observed materialities of routine care. Legitimation was identified as a crucial discursive practice in the context of staff reliance upon coercion. Trauma‐informed care represents a potentially alternative legitimacy. [ABSTRACT FROM AUTHOR]

Restraint as an intervention in the management of acute mental distress has a long history that predates the existence of psychiatry. However, it remains a source of controversy with an ongoing debate as to its role. This article critically explores what to date has seemingly been only implicit in the debate surrounding the role of restraint: how should the concept of validity be interpreted when applied to restraint as an intervention? The practice of restraint in mental health is critically examined using two post-positivist constructions of validity, the pragmatic and the psychopolitical, by means of a critical examination of the literature. The current literature provides only weak support for the pragmatic validity of restraint as an intervention and no support to date for its psychopolitical validity. Judgements regarding the validity of any intervention that is coercive must include reference to the psychopolitical dimensions of both practice and policy. [ABSTRACT FROM AUTHOR]

Tackling the problem of aggression and violence in health care is high on the agenda for healthcare professionals. In an endeavour to protect both patients and staff alike when managing aggressive behaviour, the use of physical restraint is under scrutiny, particularly as a result of the reported deaths of a number of patients whilst being restrained. The challenges of employing this type of intervention, implications for safe and effective practices and the need for the suitable training of staff are explored in this paper. [ABSTRACT FROM AUTHOR]

Focuses on the Management of Aggression and Violence Attitude Scale (MAVAS), a tool aimed to survey the views of both patients and staff about the broader approach to manage patient aggression. Review of literature on the problem of patient aggression and violence in healthcare; Overview of studies using attitude scales in healthcare research; Factor considered in launching pilot studies; Application of factor analysis to determine the validity of an instrument.