A realist synthesis to explain how, for whom and in what circumstances post-incident support (‘debriefing’) works following restrictive intervention use in mental health inpatient settings: Debriefing after Restrictive InterVEntions (DRIVE-MH)

Background: Restrictive interventions (seclusion, restraint, rapid tranquilisation) are widely used in mental health inpatient settings and can cause psychological and physical harm to patients and staff.

The National Institute of Health and Care Excellence (NICE) states that people who experience restrictive interventions should have the opportunity to debrief the experience, to address, reduce and repair the harm caused by the incident and to identify learning that can be used to reduce the likelihood of further incidents.

Aim and objectives: To undertake an in-depth and theory-informed investigation of the evidence underpinning, and current practices of, debriefing.

We will combine the extant literature on debriefing with insights from practice and experience to explain how debriefing works, for whom and in what circumstances to reduce the harm and future uses of restrictive interventions in mental health inpatient settings. Objectives: To identify initial programme theories of debriefing following restrictive interventions.

To test and refine programme theories through a focused review of the research evidence, current practice and stakeholder (patient and staff) expertise to develop explanations: Iteratively consult with stakeholders to test and refine programme theories.

Synthesise, test and refine programme theories of how post-incident support interventions repair the harm of, and reduce the likelihood of future conflict/restrictive interventions in inpatient mental healthcare.

To develop a series of pen portraits as exemplars to illustrate programme theories in partnership with stakeholders as a resource for education, training and development of service policies and procedures.

Design: A realist synthesis with collection and analysis of secondary (literature searching and review) and primary (key informant interviews) data guided by stakeholder involvement throughout.

The project will be conducted in four phases: Refining the scope and developing initial programme theories (objective i).

Evidence retrieval, review and synthesis (objective ii) Test and refine programme theories (objective ii) Development of pen portraits (objective iii) Data collection: Data will be collected via iterative literature searches, a review of NHS trust debriefing policies and key informant interviews.

Analysis: A comprehensive and iterative process of data extraction, coding and categorisation, refinement of theories, and validation against the evidence, to generate explanatory theories about how debriefing interventions work in different contexts. Expert stakeholder groups will be involved throughout the analysis.

Timeline for delivery: 12 months.

Anticipated impact and dissemination: This project will have a short-term impact by working with the Restraint Reduction Network to update their inpatient debriefing guidelines. In the longer term project is the first stage in complex intervention development.

We will seek follow-up funding to develop and test an evidence-based debriefing intervention, which if successful would benefit staff and patients.

We will use traditional methods of dissemination (e.g. conferences, academic publications) alongside more creative approaches (e.g. infographics, annotated slides, blogs) to ensure that our findings are widely shared among all key stakeholders (e.g. patients, survivors, ward staff, managers, service providers).