Establishing Components of Programmes to Reduce Restrictive Practices in Adult Mental Health Inpatient Services: A Behaviour Change Technique Analysis

Background: Incidents that threaten service user and staff safety occur frequently in adult mental health inpatient settings, often resulting in restrictive practices such as restraint and seclusion. These carry significant risks, including physical and psychological harms to service users and staff, as well as costs to the NHS. Numerous complex interventions have been developed which aim to reduce the use of restrictive practices. Aims: The aims were to identify, standardise and report the effectiveness of components of interventions that seek to reduce restrictive practices in adult mental health inpatient settings, using the Behaviour Change Technique taxonomy. Methods: A systematic mapping review of literature identified in health and social care research databases and unpublished sources (including social media) was undertaken. Records were quality appraised using the MMAT. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were included. The resulting dataset for extraction was guided by WIDER, Cochrane and theory coding guidelines. The BCT taxonomy was systematically applied to each identified intervention.Results: The final dataset comprised 175 records reporting 150 interventions, 109 of which had been formally evaluated. The most common intervention targets were seclusion and/or restraint reduction. The most common evaluation approach was a non-randomised design. There were only six randomised controlled trials. The number of BCTs identified per intervention ranged from 1-33 (mean:8). The most common strategy was staff training. BCTs from 14 of a possible 16 clusters were detected. Over two thirds of the BCTs mapped onto four of the 14 clusters: ‘Goals and planning’; ‘Antecedents’; ‘Shaping knowledge’; ‘Feedback and monitoring’. Those BCTs which were found in all the interventions were similar to those found in those interventions which demonstrated statistically significant effects. Conclusions: Studies of interventions to reduce restrictive practices appear to be diverse quality. Interventions tended to contain multiple components delivered in multiple ways. Further research could enhance the evidence base prior to future commissioning decisions. Separate testing of individual procedures, for example, audit and feedback, could ascertain the more effective intervention components and improve understanding of content and delivery. Registration: The study is registered as PROSPERO 2018 CRD42018086985 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018086985