Awareness of governmental regulations on restraints increases use/reporting

Erik Søndenaa, PhD
Forensic Dept. Brøset, St.Olavs Hospital, Norway

There has been a significant increased use of registered restraint measures in the community care for people with intellectual disability (ID) in Norway. The present study examined practitioners’ perspectives in order to find explanations for this phenomenon. It is important to note that Norwegian Social Service Act of 1999 has limited the use of restraints for persons with ID to the following: 1) emergency situations where it could not have been predicted that restraints would be necessary, and 2) planned interventions where restraint measures were included as part of an individual’s care plan. This study focuses on the latter of these two in regards to restraint use.

What did you do in your research?
A total of 195 staff members in community-based services (in Norway) were interviewed (178 were direct care staff members; 17 county governors). The survey items included possible explanations for the increased number of persons with ID legally subjected to statutory restraint in the recent past, possible future developments in these rates, and views on the consequences of the new policy for quality of care. There were also two open-ended items included around changes in care and treatment as a result of the new policy as well as other possible explanations for the observed increase in restraint episodes.

What did you find out?
Staff reported to have become more concerned about the ethics of the services after being supervised. Supervision is required as a premise in these cases. The practitioners responded that the increased number of registered restraint measures would probably continue. It was also found that staff overall were less experienced and changed their practice more in response to the new legislation. Along the same lines, it was found that staff used restraints more due to a combination of greater legal awareness and former unreported use of restraints. Although the legislation was intended to decrease the amount of restraints for persons with ID, approximately 59% of staff stated that after its implementation there was no difference in treatment of persons with ID.

What are the take-home messages?
Governmental regulation of restraints in the care for people with ID has increased knowledge and confidence of staff working with persons with ID in Norway around restraint use. However, more research is necessary about decreasing restraint measures including information around type of restraint measure employed and rationale for doing so.

To learn more about these findings contact Erik Søndenaa at and visit Brøset Centre for Research and Education in Forensic Psychiatry.

Full Journal Article
Søndenaa, E., Dragsten, F. & Whittington, R. (2015). Practitioner Explanations for the Increasing Use of Restraint Measures in the Care of People With Intellectual Disabilities in Norway 2000–11. Journal of Policy and Practice in Intellectual Disabilities, 12(1), 58–63.