Is It Ethical To Use Restraint When Treating Patients With A Mental Illness?

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Mental Illness is defined as a health condition which involves changes in emotion, thinking or behaviour (or even a combination of these) while serious mental illness is a behavioural, mental or emotional disorder. Examples of serious mental health illnesses are schizophrenia, bipolar disorder, depressive disorder. Patients with mental disorder are said to require professional health care and rarely become inpatients in a psychiatrist hospital. Before a patient is treated with mental illness or disorder, mental health must be informed. 24 out of 102 patients diagnosed with having mental problems were informed and referred to a specialist, while only 6 became inpatients at a specialist hospital.

The amount of people diagnosed with mental illness continues to rise every year which means the amount of people admitted to needing acute and crisis care is also increasing. Healthcare staffs are sometimes left in very challenging situations, where they must intervene when a person is at risk to themselves or others. In these situations, restraints should only be used as a last resort when prevention and de-escalation has proven useless. Restraints is used to keep someone or something under control and is often used in healthcare practices. The use of restraint brings forth several ethical issues, but it is used for patients with highly agitated and violent behaviour to protect the patient and other people from any possible harm. Restrictive practices can also be expressed as making someone do something they don’t wish to do, or it can also be a way of stopping someone from doing something they want to do.

The main types of restraints are physical, chemical, mechanical, technological surveillance, psychological restraints and seclusive restraint. Physical restraint is deliberately restricting a person’s movement or behaviour by holding, it is also called manual restraint. Chemical Restraint is a type of medical restraint. Using this type of restraint restricts the patient’s freedom of movement by using drugs or in some cases sedation. Mechanical Restraint using a device to prevent or subdue the movement of a person, this is often used to control the behaviour of the person. Technological surveillance restraint can be but is rarely used as an alternative to physical restraint. It is used to monitor the movement, behaviour and activity of a patient to protect the patient and staff.

Seclusion is the act of isolating patients from other patients by restricting their movement to prevent harm to others. Psychological restraint is the deprivation of a patient choice or freedom by telling what they are and what they are not permitted to do at any moment in time. During rare circumstances in which prevention and de-escalation has not worked, restraints should be done in way that it avoids pain, fear or distress to the patient, but this rarely happens as healthcare facilities such as psychiatrist hospitals are always open to abusive physical restraint.

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On the evening of October 1998, David ‘Rocky’ Bennet, a 38-year-old black male was killed as a result of physical restraint in a medium security unit in a psychiatrist hospital. 13 more related deaths via physical restraint took place after David Bennet’s death, 8 in 2011 alone. Therefore, during this process of physical restraint, it was not done well and appropriately which lead to his death. Restraint on patients always leads to spark of responses, which resulted in the majority of comments being negative. Some people said ‘‘They will never go back’’, ‘‘Terrible quality of life’’, ‘’Violent environment’’, ‘’I was repeatedly hurt’’. It was often stated that they had their property stolen from them and staffs were often stressed and overworked. In saying this, it is very important that in all circumstances, the least harmful, restrictive and most effective restraints should be used. Restraints should never be used for the sake of comfort or convenience.

Health care workers must undergo intense training to understand and follow protocol as failure to undergoing these training will result in major negative consequences for the patient. In 2015 there was 9600 uses of restraint in England & wales which included physical and mechanical restraint. Physical restraint was most frequently used in mental health services, learning disability services, physiatrist intensive care and hospitals. Out of the 9600 uses of physical restraint, there were 382 recorded uses of facedown restraint. Patients in mental health services, learning disability services, physiatrist intensive care and hospitals experienced poor communication, avoidable escalation, provocation, bullying and the fact that assumptions were made about people based on their ethnicity, culture, misunderstanding and often stereotypes. Both women and men are affected and re-traumatised by restraints, but staff response do defer for men and women.

The use of physical restraint goes against the principle of autonomy stating that a person should be able make decisions according to their own personal value. This is often known as basic to respect the autonomy of a patients. The use of restraint against patients violates their autonomy because it breaches their freedom and choices. The principle cannot be used under all circumstances, it is just impossible as various circumstances are unique which will therefore result in a change of actions. Since the use of restraint violates a patient’s autonomy, shouldn’t it be unlawful. The actions of medical staffs should be questioned and judged as they are abusing the autonomy of a patients by restraint unless they can give a valuable reason to explain their rationale actions to patients before conducting practices such as prevention and de-escalation. Patients with mental disorder and illness are associated with irresponsible or abnormally aggressive behaviour.

In most cases, physical restraint are avoidable, good communication and empathy between staff and patients de-escalates the situation and are very vital in to help reduce fear and misunderstanding. When staffs react very aggressively during situations instead of behaving calmly, it will always make the situation worse as these emotions could pass on to the patients and often lead to retaliation. Staffs react very aggressively towards patients via physical restraints even though the patient has calmed down, in these situations it is not only a cause of violating their autonomy but abusing their authority. Assumptions of people are often made based on their characteristics, past history or even physical appearance. This means that staffs often anticipate their patients’ reactions before it happens which leads to unnecessary reactions and in some cases death. Patients in psychiatric care believed changes in the systems would help them.

Changes as more information and support, better staff training, positive staff attitude to patients and during all circumstances, prevention and de-escalation before physical retaining. In conclusion, Restraining is breaching a patient’s autonomy, but it doesn’t mean it wrong as each type of restraint should be used at certain times in very specific situation for example when a patient or staff is at risk or when a patient proves to be seriously out of control. Physical restraining should only be used as a last resort to protect both staff and patient. If physical restraining is used it used be done with minimal pain to the patient and should always come after prevention and de-escalation.

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