Reducing seclusion and mechanical restraint: a systemic and decision-oriented framework for mental health services

Purpose This study aims to develop a systemic and decision-oriented model to understand the organisational factors influencing the use of restrictive measures, namely, seclusion and mechanical restraint (SMR), in psychiatric inpatient mental health services. Design/methodology/approach This study uses a modelling-based approach to identify and structure the organisational factors associated with the use of SMR in psychiatric inpatient mental health services. A qualitative coercion descriptive model (CD-Model) was constructed from literature reviews and surveys to identify influencing factors. These factors were then weighted through pairwise comparisons to develop a coercion quantitative model (CQ-Model) assessing hospitals’ capacity to minimise the use of SMR. Findings The CD-Model identified four hierarchical dimensions and 24 factors influencing coercion-related decision-making but lacked synthesis for decision makers. The CQ-Model addressed this by introducing 11 supervision indicators, derived through mathematical aggregation, providing a framework for organisational analysis. Research limitations/implications This study proposes a model-based approach that combines qualitative and quantitative methods to structure and prioritise organisational factors influencing restrictive practices. By integrating interdisciplinary expertise, the framework provides a structured and quantified representation of these factors, supporting organisational diagnosis and planning in mental health services. Practical implications The proposed framework offers a decision-support tool for organisational actors and decision makers in mental health services, linking influencing factors to specific organisational levels. The model can support institutional audits, supervision processes and quality-improvement initiatives aimed at reducing the use of SMR. Although based on data from France, the scalable structure of the framework may provide guidance for other healthcare systems. Originality/value This study introduces an original model-based approach that uniquely integrates both qualitative and quantitative methods to provide a systemic and structured analysis of coercive measures in mental healthcare, offering a scalable framework applicable across different organisational settings.