Restraint use in psychiatric emergency services: Intentions of staff vs consumer experiences in Singapore

Background: Physical restraints applied at psychiatric emergency services are infrequent but concerning. Such measures are deleterious to the health of the individual and to the working alliance that exists between the individual and service providers. Aims: To juxtapose service users’ experiences of restraints at a psychiatric emergency service in Singapore with staff’s intention. Methods: Three qualitative interviews were conducted over a year with 44 frequent service users to query their experiences with services. The views of 26 emergency department staff were also obtained. We took a descriptive phenomenological approach to analyse the data.Results: Sixteen of 44 frequent service users report being restrained at emergency services. Service users’ experiences are incongruent with the staff’s meaning of restraints, which relates to safety. The experience of being restrained began with confusion, followed by fear and irritation, ending with embarrassment. Importantly, these emotions were unaddressed during debriefing, when service users were released. Conclusions: Staff must be mindful that their actions are not perceived as intended. Additional staff training may help staff better understand the way in which service users perceive the phenomenon of restraint. De-escalation must not be done in a way that introduces anger into situations where it had previously been absent.