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The aim of this paper is to gather information that will be useful to practitioners who are assessing and trying to understand the difficulties of people with intellectual disabilities who may have experienced sexual abuse. In the first part of this paper the research into the effects of sexual abuse on people with learning disability is reviewed. In the second part of this paper, the major clinical implications of these findings are explored. These include the implications for abuse evaluations, identification of individuals at increased risk of disturbance, implications for treatment and provision of psychotherapeutic services.

The study examines the experiences of physical restraint procedures reported by nursing staff in a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Nursing staff reported a range of emotional responses to the use of restraint procedures. They included anxiety, anger, boredom, distress and crying. In some cases these responses were confirmed by descriptions from patients.Staff coped with the emotional responses to restraint in a variety of ways. Some staff discussed the ‘stigma’ attached to showing feelings to other staff. They described how laughter was used to reduce stress following an incident and how distressing emotions had to be taken home. Some staff described how they had become ‘hardened’ to the experience of restraint. A substantial proportion of staff suggested that they had ‘no’ emotional reactions and many reported ‘automatic’ responding during a restraint event in which they did not feel any emotion.Possible implications of these responses and clinical practice are discussed.

Despite the controversy surrounding physical restraint and seclusion in the care of vulnerable adults, the views of service users have had little impact on current practice. This paper reviews the literature documenting the personal views and experience of people with learning disabilities and severe mental health problems following these procedures.

This study examines the experiences of physical restraint procedures reported by in‐patients of a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Patients had differential experiences of similar physical procedures. Most reported some negative psychological experience of restraint. Anger and anxiety were two major themes. Some respondents held the perception that restraint was used to punish patients and several suggested that restraint incited further violence and aggression. Some female service users reported that restraint evoked flashbacks of previous sexual trauma.A subset of female respondents gave contrasting accounts of restraint, suggesting that they purposely brought about the restraint to gain a sense of containment or as a way to release feelings.Possible implications of these responses for clinical practice are discussed.