Carers' Perceptions of Seclusion and Restraints in Mental Healthcare: An Integrative Literature Review

The use of seclusion and restraints in mental health care is a significant international concern. Although these practices are perceived to de-escalate volatile situations and provide physical protection for those involved, they raise critical issues such as the violation of human rights, physical and emotional harm. Despite the crucial role of carers in recovery, care and protection for persons with lived experience of mental health conditions, few studies have explored their perspectives on seclusion and restraints. This integrative literature review explored carers' perceptions of these practices. A systematic search of four electronic databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted without time limitations, resulting in 10 final studies. The synthesis of the literature revealed that carers and persons with lived experience of mental health conditions have negative experiences of seclusion and restraints. However, while carers desire the elimination of seclusion and restraints, some do support the limited use, such as a 'last resort'. Importantly, many carers want to be involved before, during and after these events. Current evidence suggests that empathy is a key in de-escalation that is planned with persons with lived experience and their carers. Healthcare providers should prioritise carers' needs for engagement, emotional support and access to related information for effective reduction and elimination of seclusion and restraints. Training on de-escalation should focus on empathy, therapeutic relationships and communication during crisis. Empirical research should explore the role of carers in developing de-escalation plans.