An Exploration of Danish Forensic Hospital Staffs’ Clinical Decision-Making about the Least Restrictive Alternative Principle

The use of restrictive interventions within mental health care is greatly disputed and conflicts with human rights and autonomy principles. The least restrictive alternative principle was enacted in law to support mentally ill individuals' constitutional rights. The least restrictive alternative principle encourages staff to offer service users' the least restrictive treatment, preserving patient autonomy at the highest level possible. Previous studies identified that mental health staff have conflicting attitudes about which interventions are the least restrictive. This study investigates how Danish forensic hospital staffs perceive the least restrictive alternative principle and how these perceptions influence their perceptions of decision-making when choosing among restrictive interventions. A combination of two focus groups with nine staff members and seven individual interviews (10 nursing staff, 6 medical staff) were conducted. The data were thematically analysed, and three themes were identified: 'Staffs understanding of the least restrictive alternative', 'professional assessment', and 'individual and collective staff mechanisms'. Staff perceived clinical decision-making regarding the least restrictive alternative principle is shaped not only by adherence to legislation but also by staff composition, contextual factors, and situational dynamics. This highlights the need for both clear structural frameworks and flexibility to adapt decisions to the realities of everyday clinical practice.