The use of mechanical restraint with people who engage in severe self-injurious behaviour: impact on support staff
| Date | 09 September 2013 |
| Pages | 312-318 |
| DOI | https://doi.org/10.1108/AMHID-06-2013-0042 |
| Published date | 09 September 2013 |
| Author | Nicola Bethel,Nigel Beail |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
The use of mechanical restraint with
people who engage in severe self-injurious
behaviour: impact on support staff
Nicola Bethel and Nigel Beail
Dr Nicola Bethel is a Clinical
Psychologist, based at
Sheffield Health and Social
Care NHS Foundation Trust,
Sheffield, UK.
Professor Nigel Beail is
a Consultant Clinical
Psychologist, based at South
West Yorkshire Partnership
NHS Foundation Trust,
Barnsley, UK and University of
Sheffield, Sheffield, UK.
Abstract
Purpose – There continues to be a small group of people who have intellectual disabilities who need some
form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts
their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices,
there is very limited literature looking at the impact the use of mechanical restraints has upon service users
and support staff using them. The aim of this study was to ascertain the experiences of support staff who
apply the restraints to the people they support.
Design/methodology/approach – Qualitative methodology was utilised. A semi-structured interview was
conducted with nine support workers who: directly worked with a client with intellectual disabilities who
engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-
disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and
they had to have been directly involved in the application and removal of the mechanical restraints in the last
week. Content analysis utilising emergent coding was used to analyse the data.
Findings – All participants described using mechanical restraints as having a negative impact upon them.
Participants said they manage the negative impact by reframing, inhibiting their emotions, followingsupport
plans closely and gaining support from other staff. Participants described concerns and unmet needs
regarding whether they were applying the restraints correctly, the responsibility of teaching others to use
restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints
is not talked about. Recommendations for practice are made.
Originality/value – This is the first study to explore the views of care staff who are required to use
mechanical restraint. It provides insight on the impact of this on them.
Keywords Mechanical restraint, Self-injurious behaviour, Support staff
Paper type Research paper
In recent years there has been a focus on reducing the use of methods of restraint in services
(Allen, 2010). Despite this there continues to be a small group of people who have intellectual
disabilities who need some form of restraint in their support plan. This is particularly the case for
that group of people who engage in severe self-injurious behaviour.This group often need some
form of mechanical restraint to restrict their freedom of movement to prevent self-injury.
Mechanical restraint has been defined as “[y] the use of arm cuffs or splints to prevent self-
injury as restrictive” (Department of Health, 2002, p.10).
There is a growing literature on the use of mechanical restraint, but in recent years this has
focused on governance issues such as the extent of its use (Webber et al., 2011), ethical issues
(Kontio et al., 2010) and policy (Hughes, 2009) all within an emerging culture of minimal restraint
and where there is restraint; approaches to reduction (Allen, 2010). Currently, there is very
limited literature looking at the impact the use of mechanical restraints has upon service users
who have intellectual disabilities and support staff applying them. Research examining the
PAGE 312
j
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 7 NO. 5 2013, pp. 312-318, CEmeraldGroup Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-06-2013-0042
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