Physical restraint of people experiencing mental health problems is a coercive and traumatic procedure
which is only legally permitted if it is proportionate to the risk presented. This study sought to examine
the decision-making processes used by mental health staff involved in a series of restraint episodes in an
acute care setting. Thirty nurses were interviewed either individually or in focus groups to elicit their
views on restraint and experience in specific incidents. Four factors which influenced the decision to restrain
were identified: contextual demands; lack of alternatives; the escalatory effects of restraint itself; and
perceptions of risk. While some of these factors are amenable to change through improvements in practice,
training and organisational culture, nurses viewed restraint as a necessary evil, justified on the basis of the
unpredictable nature of mental illness and the environment in which they worked.
© 2011 Elsevier Ltd. All ri