Exploring How the Psychological Safety of Patients Is Impacted by Restrictive Practices in Inpatient Mental Healthcare: A Qualitative Study

Restrictive practices are used to contain risk and maintain physical safety on inpatient mental health wards, but have been shown to negatively impact patient well-being and trust. Researchers and professionals have suggested that inpatient mental healthcare focuses on physical safety at the expense of psychological safety. The relationship between restrictive practices and psychological safety has not yet been explored. This study aimed to explore the impacts of receiving and witnessing restrictive practices on psychological safety, to understand what could be done to make restrictive practices psychologically safe. Eighteen semi-structured interviews were carried out with former patients (aged 20-60 years) who had been discharged for longer than 6 months from adult inpatient mental healthcare in the United Kingdom. Data were analysed using reflexive thematic analysis. Four themes were generated: (1) Reactive over proactive care: seeing the behaviour and not exploring the reason, (2) A chaotic environment cannot provide safety for patients and staff, (3) Psychological impact of the (perceived) power imbalance between staff and patients and (4) Emotionally all in it together, for better or worse. The results support that physical risk is heightened in inpatient settings, but containing this should not come at the expense of psychological safety. Supportive communication and giving small acts of control to patients should be prioritised to enhance the psychological safety of patients.