Communication and Restraint Reduction (CARR) study NI
Research type
Research Study
Full title
The Role of Staff and Team Communication in Reducing Seclusion, Restraint and Forced Tranquilisation in Acute Inpatient Mental Health Settings in Northern Ireland
IRAS ID
361502
Contact name
Mary Lavelle
Contact email
Sponsor organisation
Queen's University Belfast
Duration of Study in the UK
1 years, 0 months, 30 days
Research summary
This is an HSC R&D funded research project, which is a smaller phase of an NIHR-funded study conducted in England. The overarching aim of the study is to identify the staff practices that characterises successful management of challenging behaviour in acute mental health inpatient wards.
Background:
Over 100,000 patients are admitted to acute mental health wards annually, 40% involuntarily. Wards are under incredible pressure due to high bed occupancy rates and staff shortages. Patients are only admitted if they are extremely unwell, experiencing symptoms of psychosis (hearing voices), mania or severe depression. In England, 80% of nurses report experiencing patient aggression.
Staff manage patient aggression using communication, known as de-escalation. However, one in three de-escalations are unsuccessful and staff use restrictive practices including: restraint, seclusion and forced tranquilisation. Although rates in NI are not currently recorded or published, in England 60,000 restraints occur annually, leading to patient harm (even death), trauma, fear and feelings of being disempowered and dehumanised. Staff experience harm, anxiety and burn out costing the U.K. £69M annually.
De-escalation practice varies and training is not evidence based. Communication is clearly important in de-escalation but we don’t know what communication is effective.Design and methods
Two adult acute inpatient mental health wards will participate in the study.
1. Ethnographic observations will examine how teams prevent, respond to and learn from incidents of aggression on wards.
2. One-to-one interviews with patients (n=6), ward staff (n=4) and Trust leads (n=2) will examine their experience of aggression management within their ward.
3. Staff on-line questionnaires will examine their attitudes towards and experience of aggression management on their ward.This study will generate much needed empirical evidence to inform professional training of clinical staff in de-escalation and aggression management. Collaborations with educational partners will speed the translation of these findings into practice, improving patient care, staff wellbeing and overall safety.
REC name
HSC REC A
REC reference
25/NI/0125
Date of REC Opinion
6 Oct 2025
REC opinion
Unfavourable Opinion