An exploration of seclusion and restraint practices used with autistic in-patients: a triangulation study

Seclusion and physical Restraint practices are used within in-patient mental health settings that care for Autistic individuals to manage aggression and risk of harm to themselves or others. Autistics report that they frequently experience social, communication and sensory aspects of life differently from non-Autistic people. Some Autistic individuals may struggle to understand or cope with these aspects, which may lead to heightened behaviours or emotive outbursts that may be interpreted as challenging behaviour or risk that could compromise their safety or the safety of those around them. Recent scrutiny has highlighted that there has been an increase in failures in mental health settings where Autistic individuals have been cared for. In some cases, this has been inappropriate and resulted in the overuse of Seclusion and Restraint with Autistic individuals. Regulatory bodies such as the Care Quality Commission (CQC), which is an independent regulator of health and social care in England, have published reports that have prompted legislative changes and increased training requirements. Framed within Bronfenbrenner’s Ecological Systems Theory, this research aimed to triangulate the knowledge, experience, and involvement of key stakeholders to explore the use of Seclusion and Restraint with Autistic individuals in in-patient mental health settings in the UK. These stakeholders are professionals who work within inpatient mental health settings, family members of Autistic individuals who have experienced Seclusion, Restraint, or both within in-patient mental health settings, and Autistic individuals themselves who have been in in-patient mental health settings and have experienced or have knowledge of Seclusion and Restraint. The Bronfenbrenner framework allowed for relationships to be examined, person- centred care to be emphasised, and collaboration to be highlighted throughout. Findings from qualitative surveys and interviews revealed key themes, including the inadequate understanding of Autism from professionals, in the domains of sensory needs, communication and how Seclusion and Restraint impacts these specific domains for Autistic individuals. It was also noted that there is a need for more collaborative working with both family members and professionals, but also patients and professionals, and more training which addresses the gaps in Autism awareness and aspects such as language. Furthermore, aspects such as post- discharge trauma due to Seclusion and Restraint use also needs to be considered, and the need for more psychological safety amongst the stakeholders was also highlighted. Recommendations include ongoing training in these specific domains, the awareness of the impact of these practices, and addressing the concept of post-discharge trauma in discharge planning and establishing guardians or safe spaces for both family members and patients.