Psychiatric Quarterly

, Volume 89, Issue 1, pp 191–199 | Cite as

The Impact of ‘Being There’: Psychiatric Staff Attitudes on the Use of Restraint

  • Sagit Dahan
  • Galit Levi
  • Pnina Behrbalk
  • Israel Bronstein
  • Shmuel Hirschmann
  • Shaul Lev-Ran
Original Paper


The practice of mechanically restraining psychiatric patients is constantly under debate, and staff attitudes are considered a central factor influencing restraining practices. The aim of this study was to explore associations between psychiatric staff members’ presence and participation in incidences of restraint and attitudes towards mechanical restraints. Methods: Staff members (psychiatrists, nurses, paramedical staff; N = 143 working in a government psychiatric hospital in Israel) completed a questionnaire including personal information, participation in incidents of restraint and attitudes towards mechanical restraints. Items were categorized into the following categories: security and care; humiliation and offending; control; order; education and punishment. Results: Compared to those who were not present during restraint, staff members who were present agreed significantly less with statements indicating that restraints are humiliating and offending and agreed more with statements indicating that restraints are used primarily for security and care (p < .05). Among those present in incidences of restraint, staff members who physically participated in restraint agreed significantly more with statements indicating that restraints are a means for security, care and order, and less with statements indicating restraints are humiliating and offending, compared to those present but not physically participating in restraint (p < .05). Conclusions: These findings highlight the importance of proximity of staff members to incidences of restraints. This may have implications in understanding the professional and social discourse concerning mechanical restraints.


Staff attitudes Restraint Presence Participation 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Was obtained from all individual participants included in the study.


  1. 1.
    Lepping P, Masood B, Flammer E, Noorthoorn EO. Comparison of restraint data from four countries. Soc Psychiatry Psychiatr Epidemiol. 2016;51(9):1301–9. doi: 10.1007/s00127-016-1203-x.CrossRefPubMedGoogle Scholar
  2. 2.
    Kaltiala-Heino R, Tuohimäki C, Korkeila J, Lehtinen V. Reasons for using seclusion and restraint in psychiatric inpatient care. International Journal of Law and Psychiatry. 2003;26(2):139–49.CrossRefPubMedGoogle Scholar
  3. 3.
    Iversen VC. Mechanical restraint–A philosophy of man, a philosophy of care, or no philosophy at all? Journal of Psychiatric Intensive Care. 2009;5(01):1–4.CrossRefGoogle Scholar
  4. 4.
    Steinert T, Birk M, Flammer E, Bergk J. Subjective distress after seclusion or mechanical restraint: one-year follow-up of a randomized controlled study. Psychiatric Services. 2013;64(10):1012–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Glover RW. Special section on seclusion and restraint: Commentary: Reducing the use of seclusion and restraint: A NASMHPD priority. Psychiatric Services. 2005;56(9):1141–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Madan A, Borckardt JJ, Grubaugh AL, Danielson CK, McLeod-Bryant S, Cooney H et al. Efforts to reduce seclusion and restraint use in a state psychiatric hospital: a ten-year perspective. Psychiatric Services. 2014;65(10):1273–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Freeman M, Pathare S. WHO resource book on mental health, human rights and legislation. World Health Organization; 2005.Google Scholar
  8. 8.
    Steinert T, Lepping P, Bernhardsgrütter R, Conca A, Hatling T, Janssen W et al. Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Social psychiatry and psychiatric epidemiology. 2010;45(9):889–97.CrossRefPubMedGoogle Scholar
  9. 9.
    Raboch J, Kališová L, Nawka A, Kitzlerová E, Onchev G, Karastergiou A et al. Use of coercive measures during involuntary hospitalization: findings from ten European countries. Psychiatric Services. 2010;61(10):1012–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Beghi M, Peroni F, Gabola P, Rossetti A, Cornaggia CM. Prevalence and risk factors for the use of restraint in psychiatry: a systematic review. Rivista di psichiatria. 2013;48(1):10–22.PubMedGoogle Scholar
  11. 11.
    Bowers L. Association between staff factors and levels of conflict and containment on acute psychiatric wards in England. Psychiatric Services. 2009;60(2):231–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Klinge V. Staff opinions about seclusion and restraint at a state forensic hospital. Psychiatric Services. 1994;45(2):138–41.CrossRefGoogle Scholar
  13. 13.
    Suen LK, Lai C, Wong T, Chow S, Kong S, Ho J et al. Use of physical restraints in rehabilitation settings: staff knowledge, attitudes and predictors. Journal of Advanced Nursing. 2006;55(1):20–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Van Doeselaar M, Sleegers P, Hutschemaekers G. Professionals’ attitudes toward reducing restraint: The case of seclusion in The Netherlands. Psychiatric Quarterly. 2008;79(2):97–109.CrossRefPubMedGoogle Scholar
  15. 15.
    Tateno M, Sugiura K, Uehara K, Fujisawa D, Zhao Y, Hashimoto N et al. Attitude of young psychiatrists toward coercive measures in psychiatry: a case vignette study in Japan. International journal of mental health systems. 2009;3(1):20.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hendel T, Fradkin M, Kidron D. Physical restraint use in health care settings: Public attitudes in Israel. Journal of gerontological nursing. 2004;30(2):12–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Gelkopf M, Roffe Z, Behrbalk P, Melamed Y, Werbloff N, Bleich A. Attitudes, opinions, behaviors, and emotions of the nursing staff toward patient restraint. Issues in Mental Health Nursing. 2009;30(12):758–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Barton SA, Johnson MR, Price LV. Achieving restraint-free on an inpatient behavioral health unit. Journal of Psychosocial Nursing and Mental Health Services. 2009;47(1):34–40.CrossRefPubMedGoogle Scholar
  19. 19.
    De Benedictis L, Dumais A, Sieu N, Mailhot M-P, Létourneau G, Tran M-AM et al. Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards. Psychiatric Services. 2011;62(5):484–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Kinner S, Harvey C, Hamilton B, Brophy L, Roper C, McSherry B et al. Attitudes towards seclusion and restraint in mental health settings: findings from a large, community-based survey of consumers, carers and mental health professionals. Epidemiology and Psychiatric Sciences. 2016:1–10.Google Scholar
  21. 21.
    Whittington R, Bowers L, Nolan P, Simpson A, Neil L. Approval ratings of inpatient coercive interventions in a national sample of mental health service users and staff in England. Psychiatric Services. 2009;60(6):792–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Pollard R, Yanasak EV, Rogers SA, Tapp A. Organizational and unit factors contributing to reduction in the use of seclusion and restraint procedures on an acute psychiatric inpatient unit. Psychiatric Quarterly. 2007;78(1):73–81.CrossRefPubMedGoogle Scholar
  23. 23.
    Foster C, Bowers L, Nijman H. Aggressive behaviour on acute psychiatric wards: prevalence, severity and management. Journal of Advanced Nursing. 2007;58(2):140–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Duxbury J. An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design. Journal of psychiatric and mental health nursing. 2002;9(3):325–37.CrossRefPubMedGoogle Scholar
  25. 25.
    Marangos-Frost S, Wells D. Psychiatric nurses’ thoughts and feelings about restraint use: a decision dilemma. Journal of Advanced Nursing. 2000;31(2):362–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Festinger L, Carlsmith JM. Cognitive consequences of forced compliance. The Journal of Abnormal and Social Psychology. 1959;58(2):203.CrossRefGoogle Scholar
  27. 27.
    Myers DG, Spencer SJ. Social Psychology. McGraw-Hill Ryerson, Limited; 2006.Google Scholar
  28. 28.
    Chambers M, Kantaris X, Kontio R, Kuosmanen L, Scott A, Botelho MAR et al. The feelings and thoughts of mental health nurses concerning the management of distressed and disturbed in-patients: a comparative qualitative European study. Open Journal of Nursing. 2013;3(06):426.CrossRefGoogle Scholar
  29. 29.
    Hall JE. Restriction and control: the perceptions of mental health nurses in a UK acute inpatient setting. Issues in mental health nursing. 2004;25(5):539–52.CrossRefPubMedGoogle Scholar
  30. 30.
    Husum TL, Bjørngaard JH, Finset A, Ruud T. Staff attitudes and thoughts about the use of coercion in acute psychiatric wards. Social psychiatry and psychiatric epidemiology. 2011;46(9):893–901.CrossRefPubMedGoogle Scholar
  31. 31.
    Sailas EE, Fenton M. Seclusion and restraint for people with serious mental illnesses. The Cochrane Library. 2000.Google Scholar
  32. 32.
    Fisher WA. Restraint and seclusion: a review of the literature. American Journal of Psychiatry. 1994;151(11):1584–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sagit Dahan
    • 1
  • Galit Levi
    • 1
  • Pnina Behrbalk
    • 1
  • Israel Bronstein
    • 1
  • Shmuel Hirschmann
    • 1
  • Shaul Lev-Ran
    • 1
    • 2
  1. 1.Lev Hasharon Mental Health CenterNetanyaIsrael
  2. 2.Sackler Faculty of MedicineTal Aviv UniversityTel AvivIsrael

Personalised recommendations