What children tell us about their experiences of being physically restrained in inpatient Child and Adolescent Mental Health Services: An Interpretative Phenomenological Analysis

Abstract

Background
Within child and adolescent mental health services (CAMHS), care involves the support of complex behavioural presentations which are sometimes described as challenging. For children whose distress and behaviours require intervention, physical restraint may be deemed necessary for negating the risk of harm. There are legal, moral and ethical complications associated with physical restraint. Little is known about the perspectives of children who have experienced being physically restrained within healthcare settings. Children within inpatient CAMHS are at the centre of this study.

Research Question
What do children tell us about their experiences of physical restraint in inpatient CAMHS?

Methods
Interpretative phenomenological analysis (IPA) was used to explore children’s perceptions of their experiences of being physically restrained. The study design, documentation and development of methods (e.g. interview schedules) were informed by patent and public involvement with children and families. Ethical approval was gained from Edge Hill University (the sponsor) and the Health Research Authority.

Children were recruited from inpatient CAMHS across NHS hospital trusts in England. Informed consent (parents) and assent (children) preceded individual, face-to-face augmented semi-structured interviews. All interviews were audio recorded and transcribed verbatim for detailed structured analysis. Adherence to the distinct IPA data analysis process facilitated the emergence of subordinate and superordinate themes that were transparent and truly reflective of the children’s accounts of their perspectives of being physically restrained.

Findings
Eight children (five boys, three girls, aged 10-13 years) participated in the study. The children’s experiences of physical restraint are presented through an overarching theme based on the concept of a thunderstorm; The Gathering stage, The Thunderstorm, and The Aftermath. Children talked about how being physically restrained could start much earlier and continue long after the ‘physical’ element of the restraint. Children described traumatic and confusing experiences which had made the situation feel ‘worse’ for them and left them dealing with ‘emotional debris’ for a long time after the physical restraint. The findings informed the development of The Child-Centred Model of Experiencing Physical Restraint. Derived directly from what children have described as being important to them, the implications for them of being physically restrained and the conclusions they arrived at based upon their experiences, comparisons are discussed between the proposed model and existing adult-centred models and evidence.

Conclusion
The children’s experiences of being physically restrained is different from what is taught to health professionals by using an adult-focussed model. It is proposed that a specific child-based model could provide insights into the use of physical restraint within inpatient CAMHS.

Original Contribution to Knowledge
The experience of physical restraint was described by children as occurring over a substantially longer period of time than the current adult-based model suggests. The literature review identified gaps in the evidence linked to the effect of physical restraint for children within CAMHS. This has led to the creation of a proposed evidence-based Child-Centred Model of Experiencing Physical Restraint. This study adds the under-represented voice of children to the current evidence base.

Date of Award	16 May 2022
Original language	English
Awarding Institution	Edge Hill University
Supervisor	JOANN KIERNAN (Director of Studies), LUCY BRAY (Supervisor) & BERNIE CARTER (Supervisor)