Abstract
Introduction: The use of restrictive practices is necessary in forensic services to manage risk and maintain safety, however, restrictive practices can contradict recovery principles. There is no known research to date that has explored forensic inpatient perceptions of restrictive practice. Furthermore, there is a high prevalence of childhood trauma in forensic populations and insecure attachments, both of which may impact patient perceptions of restrictive practice, yet no previous research has explored this relationship. Method: The study used a mixed methods design with a self-report attachment style measure and a semi-structured interview to gather qualitative data about perceptions of restrictive practice. Childhood trauma data was collected from patient clinical records. 30 male participants were inpatients recruited from three NHS forensic hospitals. Data were analysed using thematic analysis and correlational statistics. Results: High levels of trauma, attachment anxiety and avoidance were prevalent in the sample and perceptions of restrictive practice varied. Quantitative analyses lacked power, but themes emerged from the qualitative data which described: being controlled by the system is hard; progression through services; the hospital environment impacts care and the need for connection, and these were discussed in relation to restrictive practice, trauma and attachment literature. Conclusion: Whilst restrictive practices help to maintain physical safety and security, they can both help and hinder psychological security of forensic services users at the same time, which is further complicated by trauma and attachment difficulties in the forensic population. Clinical implications are discussed, and the study reinforces the need for forensic services to be trauma-informed, using a whole-systems approach.