{
  "abstract": "BackgroundSelf-harm is a frequent and challenging occurrence in adult inpatient psychiatric units. The use of restrictive practice to manage self-harm incidents continues to be widespread within mental health environments despite increasing national and organisational guidance to minimise its use.\n\nPurpose/aimThe aim of this project was to introduce and evaluate a continuous quality improvement programme to progressively reduce incidents of self-harm and the use of restrictive practice. The project was set in a female acute mental health inpatient unit. The project sought to embed improvements in an inpatient units interventions, procedures, and culture and staffs mindset, and move towards a sustained collaborative and positive therapeutic and communication-based approach.\n\nMethodsA retrospective service evaluation design was employed to assess differences in the number of incidents of self-harm, enhanced observation, seclusion, restraint and rapid tranquillisation in the period following the introduction of a continuous whole-systems multimodal interventional initiative in 2019. Pre- and post-initiation data were compared (2017/18 compared to 2019/2025) to evaluate improvement and whether this had been sustained. Data were analysed using descriptive statistics, including frequencies, percentages, and means.\n\nResultsSelf-harm incidents reduced between 2017/18 and 2019, with a downward trend sustained between 2019 and 2025 (136 to 72 incidents respectively between 2019 and 2025; 47% reduction). A sustained reduction in the use of restrictive practice was shown in all domains pre- and post-initiation (2017/18 compared to 2025).\n\nClinical implicationsNo one approach will successfully reduce self-harm and the use of restrictive practice. Approaches employed have to be multi-faceted, multi-interdisciplinary, collaborative, and blend together to deliver improvement. Sustained progress requires commitment to an iterative process of continuous collaboration, improvement and adaptation.",
  "abstract_shown": true,
  "affiliations": [
    "Northamptonshire Healthcare NHS Foundation Trust"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "S. Johnson"
    },
    {
      "name": "M. Kelbrick"
    },
    {
      "affs": [
        0
      ],
      "name": "C. Griffiths"
    },
    {
      "name": "A. Al-Falahi"
    },
    {
      "name": "N. Mann"
    },
    {
      "name": "T. Robano"
    },
    {
      "name": "K. Hart"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0djeen14vqwds.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.19.26365708",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365708v1.full",
  "id": "0djeen14vqwds",
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  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365708v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "psychiatry and clinical psychology"
    ],
    [
      "openalex",
      "3203|Healthcare Decision-Making and Restraints"
    ]
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  "openalex": "W7223127857",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365708v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-19",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0djeen14vqwds.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:27Z",
      "native_id": "10.64898/2026.10.19.26365708",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365708v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:psychiatry and clinical psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "Self-harm incidents and restrictive practice use in an acute female inpatient unit: a service evaluation of a continuous multi-system improvement approach",
  "title_text": "Self-harm incidents and restrictive practice use in an acute female inpatient unit: a service evaluation of a continuous multi-system improvement approach",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:27Z",
  "url": "https://research.draconitic.com/paper/0djeen14vqwds",
  "venue": "medRxiv",
  "versions": []
}