Medical restraints are
physical restraint
Physical restraint refers to means of purposely limiting or obstructing the freedom of a person's bodily movement.
Basic methods
Usually, binding objects such as handcuffs, legcuffs, ropes, chains, straps or straitjackets are used fo ...
s used during certain medical procedures to restrain patients with (supposedly) the minimum of discomfort and pain and to prevent them from injuring themselves or others.
Rationale
There are many kinds of mild, safety-oriented medical restraints which are widely used. For example, the use of bed rails is routine in many hospitals and other care facilities, as the restraint prevents patients from rolling out of bed accidentally. Newborns frequently wear mittens to prevent accidental scratching. Some wheelchair users use a belt or a tray to keep them from falling out of their wheelchairs. In fact, not using these kinds of restraints when needed can lead to legal liability for preventable injuries.
Medical restraints are generally used to prevent people with severe physical or mental disorders from harming themselves or others. A major goal of most medical restraints is to prevent injuries due to falls. Other medical restraints are intended to prevent a harmful behavior, such as hitting people.
Ethically and legally, once a person is restrained, the safety and well-being of the restrained person falls upon the restrainer, appropriate to the type and severity of the restraining method. For example, a person who is placed in a secured room should be checked at regular intervals for indications of distress. At the other extreme, a person who is rendered semi-conscious by pharmacological (or chemical) sedation should be constantly monitored by a well-trained individual who is dedicated to protecting the restrained person's physical and medical safety. Failure to properly monitor a restrained individual may result in criminal and civil prosecution, depending on jurisdiction.
Although medical restraints, used properly, can help prevent injury, they can also be dangerous. The United States
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) estimated in 1992 that improper use of restraints results in at least 100 deaths each year, most by strangulation. FDA also noted reports of injuries — including broken bones and burns — caused by the improper use of restraints. Medical restraints in
psychiatric hospitals
Psychiatric hospitals, also known as mental health hospitals, behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociative ...
in Japan are sometimes kept on patients for weeks and months,
[長谷川利夫. (2016). 精神科医療における隔離・ 身体拘束実態調査 ~その急増の背景要因を探り縮減への道筋を考える~. 病院・地域精神医学, 59(1), 18–21.] and they are thought to have caused several deaths due to
deep vein thrombosis
Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...
and
pulmonary embolism
Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream ( embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathin ...
. More information about Japanese use of restraints is described in the page on
physical restraints.
Because of the potential for abuse, the use of medical restraints is regulated in many jurisdictions. At one time in California, psychiatric restraint was viewed as a treatment. However, with the passing of SB-130, which became law in 2004, the use of psychiatric restraint(s) is no longer viewed as a treatment, but can be used as a behavioral intervention when an individual is in imminent danger of serious harm to self or others.
Criticism
In the U.S. in the late 2010s and into the 2020s (so far), restraint of psychiatric patients and/or people with mental disorders (for all purpose other than very temporarily if another person would be in danger) has come under heavy fire from many professionals (such as those in th
Therapist Neurodiversity Collective and human rights groups (such a
Alliance Against Seclusion and Restraint, Inc.a Maryland nonprofit), often when pertaining to restraint being used in mental health institutions and against
autistic
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
people such as children in U.S. public schools.
Types
There are many types of medical restraint:
*
Four-point restraints, fabric body holders,
straitjackets are typically only used temporarily during psychiatric emergencies.
* Restraint masks to prevent patients from biting in retaliation to medical authority in situations where a patient is known to be violent.
* Lap and wheelchair belts, or trays that clip across the front of a wheelchair so that the user can't fall out easily, may be used regularly by patients with neurological disorders which affect balance and movement.
*All four side rails being in the upright position on a bed can be considered a restraint.
* Safety vests and jackets can be placed on a patient like any other vest garment. They typically have a long strap at each end that can be tied behind a chair or to the sides of a bed to prevent injury or to settle patients for satisfying basic needs such as eating and sleeping.
Posey vest
A Posey vest is a type of medical restraint used to restrain a patient to a bed or chair. Its name comes from the J.T. Posey Company, its inventor, though the term "Posey" is used generically to describe all such devices. The vest is placed on the ...
s are commonly used with elderly patients who are at risk of serious injury from falling.
*
Limb restraint
Limb restraints can be physical restraint, physical (or psychological) restraints that inhibit an individual's movement in their arms or human leg, legs. The most common limb restraint is physical, whereby restraints are fixed to the individual ...
s to prevent unwanted activity in various limbs. They are wrapped around the wrists or ankles, and tied to the side of a bed, to prevent self-harm and harm to medical staff.
Handcuffs are an example of a limb restraint.
* Mittens to prevent scratching are common for newborns, but may also be used on psychiatric patients or patients who manage to use their hands to undo limb restraints.
* A
Papoose board can be used for babies and young children.
*
Chemical restraint
A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. Chemical restraint is used in emergency, acute, and psychiatric settings to perfo ...
s are
drugs that are administered to restrict the freedom of movement or to sedate a patient.
*Holding the patient's arms down on to chair arms from behind so that another person can force-feed the person, often a child, during
ABA.
Manual techniques
A number of private national and regional companies teach physical (non-mechanical) restraint techniques for companies and agencies that care for or have custody of people who might become aggressive. The strategies vary widely, with many based on police or martial art
pain compliance
Pain compliance is the use of painful stimulus to control or direct an organism. The stimulus can be manual (brute force, placing pressure on painful areas, or use of painful hyperextension or hyperflexion on joints), use tools such as a whip or ...
techniques, with others using only pain-free techniques. Most also emphasize verbal
de-escalation
De-escalation is a human behavior that is intended to prevent escalation of conflicts. It may also refer to approaches in conflict resolution. People may become committed to behaviors that tend to escalate conflict, so specific measures must b ...
and defusing skills before using any physical skills. A non-inclusive list:
* Crisis Consultant Group (CCG) Non-Violent Physical technique.
The Mandt System
* Non Abusive Psychological and Physical Intervention (NAPPI).
* Non-Violent Crisis Intervention (NVCI) techniques.
* Professional Crisis Management (PCM).
* Professional Assault Crisis Training (ProACT).
*
Therapeutic Crisis Intervention (TCI).
Adverse effects
Throughout the last decade or so, there has been an increasing amount of evidence and literature supporting the idea of a restraint free environment due to their
contradictory
In traditional logic, a contradiction occurs when a proposition conflicts either with itself or established fact. It is often used as a tool to detect disingenuous beliefs and bias. Illustrating a general tendency in applied logic, Aristotle ...
and dangerous effects. This is due to the adverse outcomes associated with restraint use, which include: falls and injuries, incontinence, circulation impairment, agitation, social isolation, and even death.
In a 2017
The Guardian
''The Guardian'' is a British daily newspaper. It was founded in 1821 as ''The Manchester Guardian'', and changed its name in 1959. Along with its sister papers ''The Observer'' and ''The Guardian Weekly'', ''The Guardian'' is part of the Gu ...
article:As of 2021 research is still on-going as to how much restraint an cause and/or exacerbate
PTSD
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
for the person being restrained.
In a
systematic review in 2020:Research is also ongoing into the adverse mental health effects on the health workers doing the restraint.
Applicable laws
United States
Current United States law requires that most involuntary medical restraints may only be used when ordered by a physician. Such a physician's order, which is subject to renewal upon expiration if necessary, is valid only for a maximum of 24 hours.
Japan
Japanese law states that psychiatric hospitals may use restraints on patients only if there is a danger that the patients will harm themselves or others. The law also states that a designated psychiatrist must approve the use of restraints and examine the patient at least every 12 hours to determine whether the situation has changed and the patient should be removed from restraints.
However, in practice, Japanese psychiatric hospitals use restraints fairly often and for long periods. Despite being required to certify every 12 hours whether a patient still needs restraints, Japanese psychiatric hospitals keep patients in restraints for a much longer time than hospitals in other countries. According to a survey conducted on 689 patients in 11 psychiatric hospitals in Japan, the average time spent in physical restraints is 96 days.
Meanwhile, the average time in most other developed countries is at most several hours to tens of hours.
The number of people who are physically restrained in Japanese psychiatric hospitals continues to increase. In 2014 more than 10,000 people were restrained-the highest ever recorded, and more than double the number a decade earlier. It is thought that some of that increase includes older patients with dementia. As a result, the Japanese Ministry of health has revised its guidelines for elderly people in nursing homes to have more restrictions against body restraints. The changes took effect on 1 April 2018.
United Kingdom
The Millfields Charter is an
electronic
Electronic may refer to:
*Electronics, the science of how to control electric energy in semiconductor
* ''Electronics'' (magazine), a defunct American trade journal
*Electronic storage, the storage of data using an electronic device
*Electronic co ...
charter which promotes an end to the teaching to frontline healthcare staff of all prone (face down) restraint holds. In June 2013 the UK government announced that it was considering a ban on the use of face-down restraint in English mental health hospitals.
Face down restraints are used more often on women and girls than on men. 51 out of 58 mental health trusts use restraints unnecessarily when other techniques would work. Organisations opposed to restraints include
Mind and
Rethink Mental Illness
Rethink Mental Illness is a mental health charity in England. The organisation was founded in 1972 by John Pringle whose son was diagnosed with schizophrenia. The operating name of 'Rethink' was adopted in 2002, and expanded to 'Rethink' Mental Il ...
. YoungMinds and Agenda claim restraints are "frightening and humiliating" and "re-traumatises" patients especially women and girls who have previously been survivors of physical or sexual abuse. The charities sent an open letter to health secretary,
Jeremy Hunt
Jeremy Richard Streynsham Hunt (born 1 November 1966) is a British politician who has served as Chancellor of the Exchequer since 14 October 2022. He previously served in the Cabinet as Secretary of State for Culture, Olympics, Media and Sport ...
showing evidence from 'Agenda, the alliance for women and girls at risk', revealing that patients are routinely restrained in some mental health units while others use non-physical ways to calm patients or stop self-harm. According to the letter over half of women with psychiatric problems have suffered abuse, restraint can cause physical harm, frighten and humiliate the victim. Restraint, specially face down restraint can re-traumatise patients who previously suffered violence and abuse. "Mental health units are meant to be caring, therapeutic environments, for people feeling at their most vulnerable, not places where physical force is routine."
Government guidelines state that face down restraint should not be used at all and other types of physical restraint are only for last resort. Research by Agenda found one fifth of women and girl patients in mental health units had been physically restrained. Some trusts averaged over twelve face down restraints per female patient. Over 6% of women, close to 2,000 were restrained face-down in total more than 4,000 times. The figures vary widely between regions.
Some trusts hardly use restraints, others use them routinely. A female patient was in several hospitals and units at times for a decade with mental health issues, she said in some units she was restrained two or three times daily. Katharine Sacks-Jones director of Agenda, maintains trusts use restraint when alternatives would work. Sacks-Jones maintains women her group speak to repeatedly describe face down restraint as a traumatic experience. On occasions male nurses have used it when a woman did not want her medication. "If you are a woman who has been sexually or physically abused, and mental health problems in women often have close links to violence and abuse, then a safer environment has to be just that: safe and not a re-traumatising experience. (...) Face-down restraint hurts, it is dangerous, and there are some big questions around why it is used more on women than men."
[End humiliating restraint of mentally ill people, say charities](_blank)
/ref> The use of restraints in UK psychiatric facilities is increasing.Mental health trusts restrain patients 'every 10 minutes'
''BBC #REDIRECT BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
...