‘Catching your tail and firefighting’: the impact of staffing levels on restraint minimisation efforts.

Introduction: Safe staffing and coercive practices are of pressing concern for mental health services. These are inter-dependent and the relationship is under-researched.
Aim: To explore views on staffing levels in context of attempting to minimise physical restraint practices on mental health wards. Findings emerged from a wider dataset with the broader aim of exploring experiences of a restraint reduction initiative.
Methods: Thematic analysis of semi-structured interviews with staff (n=130) and service users (n=32).
Results: Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimise physical restraint. We titled the themes – ‘insufficient staff to do the job’; ‘detriment to staff and service users’; ‘a paperwork exercise: the burden of non-clinical tasks’; ‘false economies’; and, ‘you can’t do these interventions’.
Discussion: Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative, and organisational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff.
Implications for Practice: Restrictive practices are unlikely to be minimised unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals’ distress.