Content note: suicide attempts, self-harm, iatrogenic harm
In February 2023 after experiencing a significant decline in my mental health, I accepted an informal admission to a psychiatric hospital hoping that it would offer safety, care, and containment (in the gentlest sense of the word). Instead, it became one of the most traumatising experiences of my life. The word “informal” suggests choice, but my experience felt much more complicated. In theory, I had agreed to be there. In practice, the door locked behind me, my belongings were removed, and any attempts to regulate myself were interpreted through the lens of risk. Even before I was formally sectioned under the Mental Health Act, just three days after my arrival, my freedom felt conditional.
I am not suggesting there was no risk. There was. I had attempted suicide multiple times before my admission, and there were times in hospital when staff found me in life-threatening situations. But often the way that risk was managed – through restraint, rapid tranquillisation, increased observations, removed belongings, restricted movement, and limited autonomy – not only intensified my distress, but also increased the very risk it intended to reduce. My behaviour did not escalate in a vacuum. It escalated in a context where my distress was repeatedly met with restriction rather than understanding.
Self-harm was a coping strategy that had been present in my life long before I was admitted to a psychiatric hospital. It was not something I experienced as random or meaningless; it was one of the only ways I knew to survive overwhelming distress – to externalise pain I could not otherwise contain, and to regain some sense of control when everything inside me felt unbearable. Outside of hospital, it had happened privately on my own terms. Inside hospital, the same distress was responded to through 2:1 observation, a stripped room, physical restraint, and rapid tranquillisation. What had been my way of coping became something to be managed. In those moments, what I really needed was care, compassion and understanding. Instead, I was met with control and containment.
So what does it mean when distress is responded to as risk? And what happens when the interventions used to “keep people safe” are experienced as harm?
Restrictive interventions, including physical restraint, rapid tranquillisation, seclusion, segregation, and other practices that limit a person’s movement, freedom, or autonomy are often described as necessary for safety. But safety is not neutral. Who is seen as risky, what is seen as dangerous, and which responses are considered justified are all shaped by systems of power. This framing does more than describe risk – it produces it. It positions distress as danger and legitimises control as care. In practice, this can mean that behaviours associated with overwhelming distress, such as self-harm, are treated as problems to be contained, rather than expressions of need to be understood. At times, it felt like these interventions were less about keeping me safe and more about making me easier to manage: easier to contain, less of a problem.
Being restrained is not just a physical act. It is an experience of having control taken away at a moment of vulnerability. The addition of rapid tranquillisation intensifies this further, removing not only physical autonomy but also the ability to remain present and oriented. Rapid tranquillisation is often used as a way to “reduce distress”, when in reality it overrides it. It acts on the body in a way that removes control without consent, leaving the person sedated rather than supported – quietened rather than cared for.
For survivors of abuse, particularly where trauma has involved violations of bodily autonomy or control, these interventions can be deeply retraumatising. They can reproduce dynamics of powerlessness, fear, and helplessness, not because that is the intention, but because that is how they are experienced. The body does not necessarily distinguish between past and present in these moments. What is framed as “safe care” instead feels like a re-enactment of harm.
Current NHS guidance emphasises the need to reduce restrictive practice and to create a “culture of care” based on compassion, dignity, and the least restrictive approaches possible. These frameworks recognise the importance of understanding distress and preventing harm, rather than responding to it through control.
Despite these commitments, restrictive interventions including physical restraint, rapid tranquillisation, segregation and seclusion continue to be used widely within mental health services. Recent research by Fradley and Haines-Delmont (2026), looking at national trends in England between 2017 and 2025, found that restrictive interventions involving women have not decreased, but increased by approximately 11–12% per year overall. The same research highlights that, for women, these interventions can carry heightened risks of re-traumatisation, particularly where there are histories of interpersonal trauma, abuse, or sexual violence.
This is not just about individual staff decisions. It is about the wider systems staff are working within: systems shaped by targets, reporting requirements, staffing pressures, fear of blame, and organisational anxiety about risk. When services are told to reduce one form of restrictive practice without addressing the conditions that produce distress in the first place, control can simply change form. Physical restraint may be reduced, while other forms of restriction increase: rapid tranquillisation, constant observation, removed belongings, locked doors, or limits on movement. On paper, this can look like progress. For the person experiencing it, it can still feel like control.
If we are serious about reducing harm in mental health services, we need to move beyond frameworks that conflate distress with danger. This means questioning not only individual interventions, but the systems and assumptions that underpin them. It requires a shift towards approaches that prioritise relationships, context, and understanding.
Because if “care” is experienced as frightening and re-traumatising, we need to ask what is not working.