'In the Midst of a Thunderstorm' - Young People's Experiences of Physical Restraint in Inpatient Mental Health Services in the UK

Sep 30, 2026

Uploaded by Kyle

Within inpatient mental health services, young people who express distress through behaviours may be physically restrained, yet little is known about their experiences or perspectives. This qualitative Interpretative phenomenological analysis study explored young people’s accounts from three inpatient mental health units in England using face-to-face, audio-recorded semi-structured interviews. Eight participants (aged 10–13) described a thunderstorm trajectory across pre-escalation, restraint, and aftermath, including prolonged emotional ‘debris’ and missed opportunities for de-escalation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

Background

Restrictive interventions and legal/ethical framing

De-escalation and sensory environment adjustments

International Journal of Mental Health Nursing ORIGINAL ARTICLE OPEN ACCESS ‘In the Midst of a Thunderstorm’: Young People's Experiences of Physical Restraint in Inpatient Mental Health Services in the UK Simon Nielson1 | Lucy Bray2 | Bernie Carter2 | Joann Kiernan3 1School of Allied Health Professions and Nursing, University of Liverpool, Liverpool, UK | 2Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK | 3Alder Hey Hospital, Liverpool, UK Correspondence: Simon Nielson ([snielson@liverpool.ac.uk](snielson@liverpool.ac.uk)) Received: 15 September 2025 | Revised: 8 December 2025 | Accepted: 14 December 2025 Keywords: child and adolescent inpatient services | mental health services | physical restraint | restrictive interventions | young people ABSTRACT Within inpatient mental health services, young people who express distress through behaviours may be physically restrained. Little is known about their experiences or perspectives of this restraint. This qualitative Interpretative phenomenological analysis (IPA) study explored young people's experiences of physical restraint. Young people were recruited from three inpatient mental health units in England. Individual, face-to-face augmented, audio-recorded semi-structured interviews were undertaken. IPA data analysis facilitated the development of subordinate and superordinate themes. The study design was informed by public consultation with young people and their families. Eight young people (five boys, three girls, aged 10–13 years) shared their experiences of physical restraint. The findings are presented within the trajectory of a thunderstorm within three themes: The Gathering (‘pre-escalation’), The Thunderstorm (the restraint), and The Aftermath (‘debriefing and making sense’). Young people talked about how feelings of being restrained could start long before any physical touch and could continue long after the physical element of the restraint had ended. They described emotional, traumatic and confusing experiences of restraint and often being left with emotional ‘debris’ for a long time after the incident. They also described situations where physical restraint was used instead of an investment in de-escalation strategies. The current understanding of the trajectory of physical restraint for children and young people within mental health units needs to be adapted to recognise the extended gathering and aftermath stages associated with this intervention. 1 | Introduction Within the UK, inpatient children and young people's mental health services (CYPMHS) offer 24-h care for children and young people aged under eighteen who have difficulties with their mental health or wellbeing (Health Education England 2024) . Multi-disciplinary teams within CYPMHS care for children and young people with a wide range of emotional, mental health and psychiatric issues (Association of Child and Adolescent Mental Health 2021) . Restraint is often used within these services (Moell et al. 2024) in response to children and young people who express their distress through behaviours that can harm themselves or cause harm to others. In the UK, the Mental Health Units (Use of Force) Act 2018 defines physical restraint as the use of physical contact that is intended to prevent, restrict or subdue movement of any part of the patient's body (Department of Health and Social Care 2021) . There is a drive to examine and reduce the use of restrictive interventions including physical restraint (Baker et al. 2021) . To date this has focussed largely on the use of restrictive practices and restraint within adult settings (Bennetts et al. 2024) and little is known about the experiences of children and young people who have This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2026 The Author(s). International

FAQs

What does the study investigate about physical restraint in inpatient mental health services?

The study explores young people’s experiences and perspectives of being physically restrained in inpatient mental health services, where distress may be expressed through behaviours.

How were participants recruited and what method was used for data collection?

Young people were recruited from three inpatient mental health units in England and took part in individual face-to-face, augmented, audio-recorded semi-structured interviews.

What themes describe the trajectory of physical restraint in the findings?

Findings are presented as a thunderstorm trajectory with three themes: The Gathering (‘pre-escalation’), The Thunderstorm (the restraint), and The Aftermath (‘debriefing and making sense’).

What implications does the paper suggest for understanding and reducing restraint?

The paper argues that the trajectory needs adaptation to recognise extended gathering and aftermath stages, and highlights that restraint can be used instead of investing in de-escalation strategies.

Sep 30, 2026

Uploaded by Kyle