Physical Restraint Techniques In Psychiatric Care
What is a Physical Restraint? In treatment settings for people with mental health and/or intellectual disabilities, restraints are facility approved maneuvers applied to limit (restrict) an individual’s movements in moments when they have become assaultive or pose a danger to themselves or others. This is often categorized as a loss of self-control, or escalating ‘behaviors’ that are gradually rising to the point of the loss of control.
The individual in ‘crisis’ will have their movements restricted for a previously approved amount of time, or until they are seen to be at a stage where they have regained control of themselves.
In recent years, these techniques have increasingly been regarded as an inhumane approach for mental health treatment, however with limited options to replace them, restraints continue to be used, and approved by governmental oversight entities. However, increasingly, there are requirements that committees are developed at each facility where they are used and that these committees will review and report each use of restraint, and consider the ethics of the specific use, along with consideration of alternative remedies. Facilities must also report the use of all restraints to oversight entities and the insurance companies that are funding the individual treatment of the person that has been restrained.
“The frequency of physical restraint use on admitted patients in mental health settings ranges from 3.8% to 51.3% worldwide. Several investigations have claimed that the frequency of physical restraint use on psychiatric inpatients considerably increased in the recent decade.
“The application of physical restraint causes practical and ethical controversies, because it results in various unexpected effects on patients and nurses. However, the use of physical restraint is an effective approach to avoid further injury by reducing the patient's physical movemen . Medical practitioners agree that applying physical restraint under urgent circumstances is rational, but it may be abused with the intention of punishment due to theoretical ambiguity.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722410/
Use of physical restraints has greatly decreased over the last fifty years, as has the types of techniques approved for use of restraint.
Ironically, use of restraint procedures are statistically higher in treatment settings for children and adolescents.
“Seclusion and restraints are used to manage aggressive behaviors in pediatric acute mental health service settings, with utilization rates much higher than those seen in adult services[1][2][3]. In youth, reported rates are as high as 26% of patients experiencing seclusion and 29% receiving restraints” (www.researchgate.net).
Included as ‘risk factors’ that might contribute to the increased use of restraint for children in treatment settings listed by researchgate are: “past or current aggression and/or violence, suicidal behavior, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent”.
Non-white ethnicity. The character Babe states in my book: A BLIND EYE: “If you’re not Black, to me, you are White” This ‘risk factor’ is also known as preconceived bias, or the perception that people of color are more dangerous, or less able to control themselves. This perception is as intrinsic in the American psyche as the concept of inalienable rights. I comes from the creation of the barbaric African. It rides along in the bowels of slaveships as justification for the capture and enforced bondage of a nation. It is the excuse used to justify slavery and apartheid, separatism and Jim Crow.
This risk factor also jumps from racism to elitism with the inclusion of ‘poor families’. People from less advantaged families, regardless of race, are perceived as having less ability to control themselves, more in need of the application of restraints.