Damaging dichotomies and confounding contradictions in mental health inpatient nursing: Lessons learned from Orwell’s 1984

Purpose: Our research poster will refer to our published paper of the same name. Our paper published earlier this year, considered the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches needed, especially where the diagnostic label of personality disorder intersects with risk. Background: In our paper, key concepts from Orwell’s 1984 were explored for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices often arise from dichotomous thinking and externalised fears. Methods: Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, we used Orwell’s novel in our paper to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings, and we questioned whose interests’ these restrictive practices serve. Conclusions: Our paper highlighted the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges. To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, we argued for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care.