# ‘In the Midst of a Thunderstorm’: Young People's Experiences of Physical Restraint in Inpatient Mental Health Services in the UK

## TL;DR

This study explores how young people in UK mental health units experience physical restraint, revealing emotional trauma and the need for better de-escalation strategies.

## Contribution

The study introduces a novel framework for understanding physical restraint as a process with emotional stages before, during, and after the event.

## Key findings

- Young people described emotional distress beginning before physical restraint occurred.
- Restraint often left lasting emotional effects, termed 'emotional debris'.
- Physical restraint was frequently used instead of de-escalation strategies.

## Abstract

Within inpatient mental health services, young people who express distress through behaviours may be physically restrained. Little is known about their experiences or perspectives of this restraint. This qualitative Interpretative phenomenological analysis (IPA) study explored young people's experiences of physical restraint. Young people were recruited from three inpatient mental health units in England. Individual, face‐to‐face augmented, audio‐recorded semi‐structured interviews were undertaken. IPA data analysis facilitated the development of subordinate and superordinate themes. The study design was informed by public consultation with young people and their families. Eight young people (five boys, three girls, aged 10–13 years) shared their experiences of physical restraint. The findings are presented within the trajectory of a thunderstorm within three themes: The Gathering (‘pre‐escalation’), The Thunderstorm (the restraint), and The Aftermath (‘debriefing and making sense’). Young people talked about how feelings of being restrained could start long before any physical touch and could continue long after the physical element of the restraint had ended. They described emotional, traumatic and confusing experiences of restraint and often being left with emotional ‘debris’ for a long time after the incident. They also described situations where physical restraint was used instead of an investment in de‐escalation strategies. The current understanding of the trajectory of physical restraint for children and young people within mental health units needs to be adapted to recognise the extended gathering and aftermath stages associated with this intervention.