Experiences of restrictive practices in child and adolescent mental health inpatient care: an integrative review.

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).