Self-harm incidents and restrictive practice use in an acute female inpatient unit: a service evaluation of a continuous multi-system improvement approach
- 1Northamptonshire Healthcare NHS Foundation Trust
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.
Purpose/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.
MethodsA 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.
ResultsSelf-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).
Clinical 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.
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BibTeX
@misc{johnson2026selfharm,
title = {{Self-harm incidents and restrictive practice use in an acute female inpatient unit: a service evaluation of a continuous multi-system improvement approach}},
author = {S. Johnson and M. Kelbrick and C. Griffiths and A. Al-Falahi and N. Mann and T. Robano and K. Hart},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.19.26365708},
url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365708v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Self-harm incidents and restrictive practice use in an acute female inpatient unit: a service evaluation of a continuous multi-system improvement approach
AU - S. Johnson
AU - M. Kelbrick
AU - C. Griffiths
AU - A. Al-Falahi
AU - N. Mann
AU - T. Robano
AU - K. Hart
PY - 2026
DA - 2026/10/19
PB - medRxiv
DO - 10.64898/2026.10.19.26365708
UR - https://www.medrxiv.org/content/10.64898/2026.10.19.26365708v1
AB - 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. Purpose/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. MethodsA 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. ResultsSelf-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). Clinical 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.
ER -