Rules and Limit-Setting in Adolescent Inpatient Psychiatric Wards: A Systematic Narrative Review

Inpatient psychiatric wards are a crucial, albeit unique, part of the paediatric mental healthcare system. By their nature they exert greater control over their patients' daily lives, by means of rules and restrictions on behaviour, than do other types of health services. As such, it is essential to have a clear and comprehensive understanding of what rules and structures are reasonable to impose in these settings. Limited literature exists on this topic, particularly relating to adolescent inpatient mental health settings.

This paper reports a systematic narrative review of existing knowledge on structures of rules on adolescent inpatient psychiatric wards.

A search of databases (PsycINFO, Medline, and Embase) identified 31 papers meeting inclusion criteria.

Data extraction and analysis of included papers revealed six themes: descriptions of rules and behaviour structures, the flexibility of rules, the rationale for rules, patient autonomy and involvement in the development of rules, and outcomes of rule structures.

Implications for practice include a recommendation for adolescent inpatient wards and their governing policies and procedures to take these elements into account when devising ward rules and structures. We hope the findings of this review will improve consistency of care in adolescent inpatient settings, reduce arbitrariness of behaviour restrictions, and enable future research to evaluate the impact of rules on mental health outcomes.