Patients’ experiences and perceptions of physical restraint in psychiatric care: A descriptive qualitative study at Muhimbili National Hospital

Abstract

Physical restraint in psychiatric care remains controversial due to ethical concerns and the risk for physical and psychological harm. Despite its continued use to manage aggression and maintain safety, evidence on patients' experiences in low-resource settings, including Tanzania, is limited. This study explored patients' experiences and perceptions of physical restraint during psychiatric hospitalization at Muhimbili National Hospital. A qualitative descriptive design was used involving 14 purposively selected adult patients who had experienced physical restraint. Data were analyzed using thematic analysis, and seven themes were identified. Participants described restraint as a complex intervention with both perceived benefits and significant harms. While some acknowledged its role in preventing violence, maintaining ward safety, and supporting treatment during acute agitation, many reported negative experiences, including pain and injury, loss of dignity, humiliation, lack of explanation, ignored requests for assistance, and feelings of coercion or punishment. Limited involvement in decision making and the absence of post-restraint debriefing further undermined trust in healthcare providers. Although some participants accepted restraint as necessary in certain situations, many recommended alternatives, such as verbal de-escalation, attentive communication, pharmacological calming, and close observation. When restraint was unavoidable, patients emphasized the need for humane implementation, including minimal force, short duration, continuous monitoring, and respectful interaction. Overall, physical restraint was experienced as both protective and potentially harmful. The findings highlight the need for context-specific patient-centered approaches that prioritize communication, alternatives to restraint, post-restraint engagement, and staff training to strengthen ethical and rights-based mental health care in Tanzania.