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Abstract

Background
Global initiatives to reduce restrictive practices in mental health settings have gained increasing attention. However, discrepancies in restrictive practice rates create uncertainties about whether these variations reflect true differences in clinical practices or arise from inconsistent classification and reporting methods.

Aims
This study investigated how healthcare professionals classify and report potential restrictive practice scenarios, and examined variations in classification and documentation across diverse facilities.

Method
This was an international survey conducted using an online questionnaire via the Qualtrics platform. Healthcare professionals working in adult mental health in-patient settings were recruited through multiple media platforms and snowball sampling. The questionnaire included 44 potential restrictive practice case scenarios. Participants rated each scenario as follows: (a) whether it should be classified as a restrictive practice; (b) whether it should be recorded as such; (c) whether it would be classified as a restrictive practice within their facility; and (d) whether it would be reported as a restrictive practice in their facility. Survey development was guided by systematic reviews and co-design work with stakeholders. Data were analysed using ordered regression models, with clustering by participant identity and country. Robust standard errors were applied to ensure accurate estimation of variability.

Results
A total of 491 healthcare professionals from 41 countries participated. Results indicated substantial inconsistencies in clinicians’ perspectives regarding what constitutes restrictive practices and whether a given action should be reported as a restrictive practice. Although participants frequently identified scenarios as restrictive practices, their intention to report them was considerably lower. Additional discrepancies were observed between clinicians’ individual perspectives and their expectations of how these practices were actually being classified and reported as restrictive practices within the in-patient facilities where they work.

Conclusions
Discrepancies between healthcare professionals’ classification of restrictive practices and their reporting intentions, as well as between their perspectives and actual institutional practices, highlight potential errors in current reporting systems. These findings underscore the need for standardised definitions, enhanced reporting frameworks and structured training programmes and monitoring mechanisms to improve consistency in the management of restrictive practices across mental health settings.

Publication Type:	Article
Additional Information:	© The Authors. Published by Cambridge University Press. This is an open-access article distributed under the terms of Creative Commons: Attribution License 4.0 (http://creativecommons.org/licenses/by/4.0/).
Publisher Keywords:	Restraint, seclusion, restrictive practice, mental health, definition
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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