Reducing restrictive inpatient practices for children who self-harm
Research type
Research Study
Full title
Studying Potential Alternatives to Restrictive inpatient practices for Children who Self-harm (SPARCS)
IRAS ID
291817
Contact name
Robert Griffiths
Contact email
Sponsor organisation
Greater Manchester Mental Health NHS Foundation Trust
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
Researsch Summary -
Rates of self-harm amongst children are increasing. Staff working with children who self-harm in inpatient settings frequently have to make judgements about when it is appropriate to use restrictive practices to prevent service users harming themselves. There is evidence that around a quarter of children and young people treated in mental health inpatient settings experience at least one seclusion episode and 29% at least one restraint episode.
This is a problem because restrictive practices are often experienced as traumatic by children and are associated with feelings of distress, fear, and loss of control. Key policy documents have outlined an intention to reduce the use of restraint for children, although questions remain about the most effective methods for achieving this.
In this 12-month qualitative study, we aim to recruit children with experience of engaging in self-harm in mental health inpatient settings. Recruitment will take place via Greater Manchester Mental Health NHS Foundation Trust's (GMMH) Child and Adolescent Mental Health Service (CAMHS). Using semi-structured interviews, we will seek to understand the experience of children of restrictive practices and identify their preferences for how they would like staff to respond to incidents of self-harm. We will also interview parents/carers and members of staff to seek their views on these issues. We intend to conduct around 20 interviews in total. Interviews will be transcribed and analysed qualitatively to identify common themes.
The results of this study will be used to inform policy, practice, and future research into the development of interventions that do not rely on restrictive practices for children who self-harm in inpatient settings.
Summary of Results -
This study aimed to understand the views of children and young people (CYP), parents and staff on how staff should respond to incidents of self- harm carried out by CYP in mental health inpatient settings. We conducted semi-structured interviews with six CYP, five parents, and six mental health professionals. We found two broad themes: (1) "The threshold for intervening" and (2) "Interpersonal attributes of staff". There was general agreement amongst the three groups of participants about the interpersonal skills required by staff to work with this population. Staff who were seen to make efforts to engage with CYP and actively participated in ward life, conveyed a sense of caring for the CYP, and could respond flexibly to the needs of CYP were more likely to be perceived as helpful. There was disagreement between participants about the appropriate threshold for intervening when CYP self-harm in inpatient settings. Staff were keen to avoid the use of restrictive practices, such as restraint, unless absolutely necessary to preserve the safety of CYP. Parents, however, thought that staff should use restrictive practices at an earlier stage. Our findings suggest that further work is needed to develop effective approaches for addressing self- harm in this population which are considered acceptable to all key stakeholders. The results of this study could be used to inform future intervention development.
REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
21/YH/0043
Date of REC Opinion
24 Mar 2021
REC opinion
Favourable Opinion