Exploring the contribution of participants’ perspectives to mental health practice: An ethnographic study of physical restraint in a psychiatric unit Odysseas Anastasopoulos & Eugenie Georgaca Psychology Department Aristotle University of Thessaloniki Qualitative Research on Mental Health Conference The University of Nottingham, August 2010

Introduction Shift from views to practices Process of physical restraint Process of physical restraint Factors implicated in its course and outcome Factors implicated in its course and outcome Contributions of all parties involved Contributions of all parties involved Role of context Multi-determined yet flexible character of mental health practice

Methodology Ethnographic study Ethnographic study Takes place in an inpatient unit of the Thessaloniki Psychiatric Hospital Takes place in an inpatient unit of the Thessaloniki Psychiatric Hospital Multiple case design Multiple case design

Methodology Data collection methods Data collection methods Participant observationParticipant observation Short informal interviewsShort informal interviews Semi-structured interviewsSemi-structured interviews Police, judicial and medical recordsPolice, judicial and medical records Grounded theory analysis Grounded theory analysis

Main themes Restraint as a traumatic experience Restraint as a traumatic experience Restraint as a symbolic means of exercising power and setting limits Restraint as a symbolic means of exercising power and setting limits Attempting to negotiate a pre-made decision Attempting to negotiate a pre-made decision Restraint as a process subject to ongoing negotiation Restraint as a process subject to ongoing negotiation

1. Restraint as a traumatic experience Continuous plea for release Continuous plea for release Experience of restraint as traumatic Experience of restraint as traumatic

2. Restraint as a symbolic means of exercising power and setting limits Official / staff reasons for restraint Official / staff reasons for restraint Restraint experienced as punishment Restraint experienced as punishment Restraint as a way of enforcing limits Restraint as a way of enforcing limits Restraint as exercise of power Restraint as exercise of power

3. Attempting to negotiate a pre-made decision Contact between restrained person and doctor Contact between restrained person and doctor Strategies of persuasion used by staff during restraint Strategies of persuasion used by staff during restraint Contact between restrained person and nursing staff Contact between restrained person and nursing staff

4. Restraint as a process subject to ongoing negotiation The role of relatives The role of relatives Flow of information Flow of information Between nursesBetween nurses From nurses to doctorFrom nurses to doctor From patient to doctorFrom patient to doctor Direct negotiation between patient and nursing staff Direct negotiation between patient and nursing staff

Conclusion Restraint as a traumatic experience Restraint as a traumatic experience Shifting emphasis to the examination of practices Shifting emphasis to the examination of practices Restraint as subject to power and negotiation Restraint as subject to power and negotiation Silencing people subjected to restraint Silencing people subjected to restraint Importance of understanding mental health practices Importance of understanding mental health practices