“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts
Mick McKeown, Gill Thomson, Amy Scholes, Fiona Jones, John Baker, Soo Downe, Owen Price, Paul Greenwood, Richard Whittington, Joy Duxbury
Safe staffing and coercive practices are of pressing concern for mental health services. These are inter‐dependent, and the relationship is under‐researched.
To explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative.
Thematic analysis of semi‐structured interviews with staff (n = 130) and service users (n = 32).
Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes—“insufficient staff to do the job”; “detriment to staff and service users”; “a paperwork exercise: the burden of non‐clinical tasks”; “false economies”; and, “you can't do these interventions.”
Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff.
6 Implications for practice
Restrictive practices are unlikely to be minimized unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals’ distress.