Damaging dichotomies and confounding contradictions in mental health inpatient nursing: lessons learned from Orwell’s 1984
| Date | 15 August 2024 |
| Pages | 335-347 |
| DOI | https://doi.org/10.1108/MHRJ-11-2023-0065 |
| Published date | 15 August 2024 |
| Author | Michael Haslam,Keir Harding |
Damaging dichotomies and confounding
contradictions in mental health inpatient
nursing: lessons learned from Orwell’s1984
Michael Haslam and Keir Harding
Abstract
Purpose –This discursive paper considers the use of restrictive practices in mental health inpatient
settings and how these are often prioritised over relational approaches,especially where the diagnostic
label of personalitydisorder intersects with risk.
Design/methodology/approach –Key concepts from Orwell’s 1984 are studiedfor their pertinence to
mental health inpatient settings, supporting our argument that restrictive practicesarise from
dichotomousthinking and externalised fears.
Findings –Drawing upon Orwellian themesof power, social control and digital surveillance from 1984,
the authors highlightthe role of fear in perpetuating restrictivepractices under a guise of benevolent care
in mental health inpatientsettings, especially for those whoare diagnosed with a personality disorder.A
lack of preparedness to work with complexity in such environments, coupled with a deficit in self-
reflexivityand critical thinking, can exacerbate challenges.
Research limitations/implications –To transcend damaging dichotomies and reduce restrictive
practices in inpatient settings, the authors make the argument for the adequate preparation and
educationof the mental health nurse and authentic,collaborative, user-involved care.
Originality/value –The authors use Orwell’s novel to support a critical discourse around those
damaging dichotomiesand inherent contradictions thatcontribute to restrictive practice in contemporary
mentalhealth settings and to question whoseinterests’ these restrictive practicesserve.
Keywords Personality disorder, Risk-aversion, Restrictive practice, Inpatient, Mental health nursing,
Risk management, Fear, Anxiety, Relational practice
Paper type Viewpoint
Introduction
Our discursive paper seeks to highlight how restrictive practice is prioritised within mental
health inpatient settings, over the relational and interpersonal approaches needed, especially
when working with service users with the diagnostic labelof personality disorder. In our paper,
the links throughout to Orwellian themes of power, coercivesocial control and digital
surveillance, are purposeful; George Orwell’s 1984 (Orwell, 1949) providing a framework
against which we intend to explore the use of restrictive practice (as referring to the use of
both chemical and physical restraint) for this patient group in mentalhealth inpatient settings.
Published 75years ago this year, the relevance of this novel’s themes has never been more
pertinent to contemporary mental health inpatient care in the UK, given the failure by the
previous UK Government to see through planned reforms of the Mental Health Act, despite
its perceived obsolescence (Thomas, 2023). The necessity, however, for such reforms was
illustrated not too long ago by the BBC undercover program “Panorama” (Panorama, 2022)
and the ensuing independent review (Shanley, 2024), both of which exposed indefensible
cultures of restrictive practice and abuse in mental health inpatient settings. And in
Michael Haslam is based at
the School of Nursing,
University of Central
Lancashire, Preston, UK.
Keir Harding is based at the
Beam Consultancy,
Wrexham, UK.
Received 21 November 2023
Revised 25 July 2024
Accepted 29 July 2024
DOI 10.1108/MHRJ-11-2023-0065 VOL. 29 NO. 32024,pp. 335-347, ©Emerald Publishing Limited, ISSN 1361-9322 jMENTAL HEALTH REVIEW JOURNAL jPAGE 335
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