Peer-reviewed article
Experiences of restrictive practices in child and adolescent mental health inpatient care: an integrative review.
Larsen SU, Pedersen ML, Baker J, Hansen JP, Lemcke S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This integrative review examines how restrictive practices (such as restraint and seclusion) are used in child and adolescent psychiatric inpatient units and why they persist despite regulations aimed at reducing them. The review analyzes both quantitative and qualitative studies to understand the psychological and physical effects on young patients, families, and staff. It finds that restrictive practices continue not just during crises but become normalized through institutional culture, ethical justifications, and everyday ward practices. The authors recommend moving beyond regulation alone toward approaches that emphasize emotional safety, patient agency, and recovery.
Key points
- Restrictive practices in psychiatric inpatient units have significant psychological and physical consequences for children, adolescents, relatives, and staff
- Restrictive practices persist through multiple intertwined mechanisms: ethical justification in care, institutional and legal normalization, and embeddedness in ward culture
- Children and adolescents, relatives, and staff each shape how safety and responsibility are understood, reinforcing restrictive practices in different ways
- Experiences of restrictive practices remain underreported despite international and national regulations aimed at reducing their use
- Strategies to address restrictive practices need to extend beyond regulation toward cultural and relational approaches promoting emotional safety and recovery
Limitations
This is a literature review that synthesizes existing research rather than collecting new data, so it cannot provide prevalence data or direct measurement of the outcomes of specific interventions. The review does not specify which countries' contexts are included, limiting clarity on geographic applicability.
Abstract
Children and adolescents admitted to psychiatric inpatient units may be subjected to restrictive practices. Such practices can have significant psychological and physical consequences for the young inpatients, as well as for their relatives and the staff involved. Despite this, experiences of restrictive practices remain underreported particularly regarding the mechanisms that sustain their continued use, even in the face of international and national regulations aimed at reducing restrictiveness. A deeper understanding of these mechanisms can help nuance clinical decision-making and illuminate the complex relationships between staff, children, and relatives. This integrative review aims to provide such insights through a systematic literature search that includes both peer-reviewed and grey literature across quantitative and qualitative studies. The included papers were assessed using JBI and GRADE-CERQual and findings were analyzed using Systematic Text Condensation showing that restrictive practices persist not only due to acute crises but through intertwined mechanisms: their ethical justification in care, their institutional and legal normalization, and their embeddedness in everyday ward culture. Children and adolescents, relatives, and staff each shape how safety and responsibility are understood, reinforcing restrictive practices in different ways. These findings point to the need for strategies extending beyond regulation toward cultural and relational approaches that promote emotional safety, agency, and recovery-even when restrictive practices remain necessary. The review was preregistered at PROSPERO (CRD420251032437).