Alternatives to use of restraint: A path toward humanistic care

Restraint and seclusion are measures to restrict the movement of a person. The predominant reason cited for the use of restraint in mental health settings is the safety of the staff and the patient in times of aggression and to control problem behaviors. However, there have been significant issues in terms of ethics, rights of the patient, and the harmful effects of restraint. Recently, there has been a move in Western countries to decrease its use by incorporating alternative methods and approaches. In India, the Mental Healthcare Act of 2017 advocates the use of least restrictive measures and alternatives to restraint in providing care and treatment for person with mental illness. In this context, approach to restraints is all the more relevant. This article looks to overview the types of restraints, complications of restraints, and the alternatives to restraint in diverse settings.

[1]  Soumitra Das,et al.  Caregivers’ Attitude and Perspective on Coercion and Restraint Practices on Psychiatric Inpatients from South India , 2019, Journal of neurosciences in rural practice.

[2]  P. Lepping,et al.  Clinician attitude and perspective on the use of coercive measures in clinical practice from tertiary care mental health establishment – A cross-sectional study , 2019, Indian journal of psychiatry.

[3]  Heidi L McNeely,et al.  A Systematic Process for Selection of a Crisis Prevention/De-Escalation Training Program in the Hospital Setting , 2018, Journal of the American Psychiatric Nurses Association.

[4]  P. Lepping,et al.  Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. , 2018, Asian journal of psychiatry.

[5]  L. Baig,et al.  Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi , 2018, Pakistan journal of medical sciences.

[6]  P. Lepping,et al.  Staff and caregiver attitude to coercion in India , 2016, Indian journal of psychiatry.

[7]  C. Fall,et al.  An interpretative phenomenological analysis (IPA) of coercion towards community dwelling older adults with dementia: findings from Mysore studies of natal effects on ageing and health (MYNAH) , 2016, Social Psychiatry and Psychiatric Epidemiology.

[8]  P. Lepping,et al.  Observational study of aggressive behaviour and coercion on an Indian acute ward. , 2016, Asian journal of psychiatry.

[9]  S. Kahng,et al.  Further investigation of a rapid restraint analysis. , 2015, Journal of applied behavior analysis.

[10]  J. Tiihonen,et al.  Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. , 2013, Psychiatric services.

[11]  G. Holloman,et al.  Use and Avoidance of Seclusion and Restraint: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup , 2012, The western journal of emergency medicine.

[12]  S. Zeller,et al.  Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup , 2012, The western journal of emergency medicine.

[13]  M. Azeem,et al.  Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. , 2011, Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc.

[14]  Don E. Williams.  Reducing and eliminating restraint of people with developmental disabilities and severe behavior disorders: an overview of recent research. , 2010, Research in developmental disabilities.

[15]  J. Scanlan.  Interventions To Reduce the Use of Seclusion and Restraint in Inpatient Psychiatric Settings: What We Know So Far a Review of the Literature , 2010, The International journal of social psychiatry.

[16]  G. Joffe,et al.  Patient restrictions: Are there ethical alternatives to seclusion and restraint? , 2010, Nursing ethics.

[17]  L. Zun,et al.  Frequency of alternative to restraints and seclusion and uses of agitation reduction techniques in the emergency department. , 2007, General hospital psychiatry.

[18]  A. Dean,et al.  Behavioral Management Leads to Reduction in Aggression in a Child and Adolescent Psychiatric Inpatient Unit , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[19]  D. Donat.  Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. , 2005, Psychiatric services.

[20]  Robert H. Davis,et al.  Pennsylvania State Hospital system's seclusion and restraint reduction program. , 2005, Psychiatric services.

[21]  L. Miller,et al.  P.R.N. (As-needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications. , 2003, Psychiatric services.

[22]  D. Donat.  An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. , 2003, Psychiatric services.

[23]  B. McCormack,et al.  Side rails as physical restraints in the care of older people: a management issue. , 2002, Journal of nursing management.

[24]  L. McAleese,et al.  Perceptions of older people who have experienced physical restraint. , 2001, British journal of nursing.

[25]  R. Hunter.  Treatment, management, and control: improving outcomes through more treatment and less control. , 2000, New directions for mental health services.

[26]  A. Retsas.  Survey findings describing the use of physical restraints in nursing homes in Victoria, Australia. , 1998, International journal of nursing studies.

[27]  S. Miles,et al.  Deaths Caused by Bedrails , 1997, Journal of the American Geriatrics Society.

[28]  R. G. Smith,et al.  Self-restraint as positive reinforcement for self-injurious behavior. , 1996, Journal of applied behavior analysis.

[29]  R. Drake,et al.  Reversing a history of unmet needs: approaches to care for persons with co-occurring addictive and mental disorders. , 1996, The American journal of orthopsychiatry.

[30]  N. Ray,et al.  Use of restraint and seclusion in psychiatric settings in New York State. , 1995, Psychiatric services.

[31]  W. Fisher.  Restraint and seclusion: a review of the literature. , 1994, The American journal of psychiatry.

[32]  D. Macpherson,et al.  Mechanical restraints on the medical wards: are protective devices safe? , 1989, American journal of public health.

[33]  R. Strauss,et al.  Abrasive shirts may contribute to herpes gladiatorum among wrestlers. , 1989, The New England journal of medicine.

[34]  J. Gross,et al.  Brachial plexus injury due to vest restraints. , 1989, The New England journal of medicine.

[35]  P. Burge,et al.  Ischaemic contracture of the intrinsic muscles of the hands. A hazard of physical restraint. , 1986, Journal of hand surgery.