Below is a blog written by Rob Allison for the website The National Elf Service, Original article found here
What is meant by physical restraint in a mental health context? An international broad definition describes it as the prevention of a person’s free movement (Bleijlevens et al, 2016). This is defined more specifically in the UK as direct contact with an intention to prevent, restrict or subdue a person’s movement (Department of Health, 2014) in order to prevent harm or give treatment (Bowers et al, 2012).
Physical restraint is also defined within the literature as a hard form of coercion commonly observed in mental health inpatient settings (see Lidz et al, 1998; and Szmukler & Appelbaum, 2008, for examples of a hierarchy of different types of coercion). It is a controversial element of mental health treatment and perhaps symbolises for many a lack of genuine participation in one’s own treatment, especially at times of distress.
Indeed, recent media reports of findings from an independent review of the Mental Health Act describe an increasing use of detentions in mental health services and concern regarding the manner in which people are treated.
Recently Matthew Broome blogged here on The Mental Elf about whether or not shared decision-making is helpful for people with psychosis and commented on a complex dynamic between collaboration and coercion impacting on therapeutic relationships.
The administration of physical restraint is an example commonly seen in mental health practice where distressed behaviour directly confronts practitioners’ professional responsibilities and accountabilities. It presents practitioners with a difficultly of balancing both the rights and wellbeing of individual patients with those of other people. During physical restraint, shared decision making is severely lacking.
In this blog, I discuss a paper by Cusack and colleagues (Cusack et al, 2018) that, to some extent, touches on the complex dynamic previously highlighted by Matthew Broome. Cusack and colleagues note that most research to date has focused on quantitative approaches measuring the administration of restraint and perspectives about its use, rather than the impact of it.
The authors report their findings from an integrative review aiming to explore the physical and psychological impact of physical restraint on people admitted to mental health inpatient settings.
As stated in this blog the care we give someone with mental health issues has to be our main priority and is important to remember that no matter what has happened in someone’s past, that everyone is a Human Being and have thoughts and feelings… a little bit of respect goes a long way.
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