Preventing mechanical restraint in forensic mental health care: A secondary analysis of interviews with patients, carers, nursing assistants and nursing staff.

The use of restrictive interventions to prevent harm remains one of the most persistent challenges in psychiatry. Mechanical restraint (MR), involving belts to limit patient movement, is among the most controversial practices due to their physical and psychological consequences for both patients and staff. MR prevalence varies widely across countries and remains particularly high in forensic mental health settings. In Denmark, MR episodes have increased in recent years despite the implementation of evidence-based interventions, underscoring the need for effective, ethical, and sustainable strategies. This study reanalysed existing interview data from three stakeholder groups; patients, carers, and nursing staff, to explore perceived causes of MR and potential preventive interventions. The dataset comprised 58 interviews: 19 forensic inpatients with lived experience of MR, 15 carers, 11 registered nurses, and 13 nursing assistants. Interviews were analysed thematically. Findings indicate that staff-patient conflicts stem from patient-related factors combined with low conflict tolerance among staff. Decision-making is shaped not only by professional skills but also by personal attitudes, fear, and perceived safety, influenced by observational knowledge, patient characteristics, collegial support, and available resources. Heightened fear tends to produce strategies with negative outcomes, whereas perceived safety fosters constructive approaches. Addressing these dynamics is crucial for developing interventions that reduce MR use and promote safer forensic environments. This study is limited by its secondary analysis design and its focus on a single forensic mental health setting, which may influence the transferability of the findings.