The psychology of ‘takedown’: Emotional and cognitive processes during the emergency management of violence by physical restraint on the floor

Abstract

Background and Aims

Physical (‘hands-on’) restraint is used widely in mental health services around the world to control imminent and actual dangerous behaviour by people suffering acute mental illness. Its deployment in a supposedly caring environment generates acute ethical dilemmas for staff because of the risk of death, physical injury and/or psychological distress for both patients and staff. As a coercive intervention, it is increasingly framed professionally as a treatment failure and there is a significant effort around the world to develop alternatives at the individual and organisational level. This presentation will summarise some key findings from a series of UK studies on the psychological and social context surrounding the decision by staff to restrain a patient on the floor.

Methods

The studies have variously employed standardised instruments (e.g. ACMQ), audit data and qualitative interviews to examine the attitudes and experiences amongst patients and staff relating to restraint episodes.

Results

Attitudes toward restraint vary according to demographic factors and exposure to the technique and the decision to restrain the patient on the floor is associated with a number of contextual factors.

Conclusion

These findings will be embedded within a discussion of some relevant theories of human aggression and stress. In this way it is anticipated that our understanding of the interaction between staff and patients during crisis situations can be improved and ultimately decision-making by professionals during these episodes can be enhanced.