Practice Experience: Quality Improvement Storyboard
Excessive use of restraints and seclusion in mental health children and adolescents
Physical constraint can be defined as using force to prevent and restrict the natural movement of any part of a patient’s body. On the other hand, seclusion is socially isolating patients from other people. Restrictive strategies such as excessive restraints and seclusion have been used in the mental healthcare industry for a long time as a reactive intervention to aggressive behaviors among patients, especially children, and adolescents. Many experts agree that physical restraints often cause significant bodily injury to the patients, but the psychological effects of the practice are often ignored. Despite the knowledge that physical restraint often causes physical injuries among mental health patients, the technique is widely practiced in many mental healthcare facilities.
Impact of physical restraint and seclusion
This practice causes a deep mistrust between mental health care patients and their caregivers, significantly hindering the success of the treatment plans. Mental healthcare practitioners argue that the practice is essential in ensuring the safety of all stakeholders in the facility. The procedure is deemed necessary to prevent the children and adolescents from hurting themselves or the people around them. However, with the dawn of the Age of information, more people are informed about their rights and liberties as patients. Thus, mental healthcare practitioners who use this practice face severe legal, ethical, and moral challenges. The physicians must carefully assess their reaction to their patients’ violent behaviors. They should consider the rights and freedoms of all patients. This includes the rights to self-determination, dignity, security, and physical integrity.
Research into the use of physical restraint and seclusion
Researchers have established that physically restraining patients negatively affects their mental health (Department of Health, 2017). Restrained patients are likely to develop other mental complications such as mood disorders. However, some violent and aggressive behaviors such as kicking others, spitting on people, damaging property, hurting oneself, or other people may necessitate the use of physical restraint and seclusion among mental health care patients. Nevertheless, the physicians enforcing these techniques should understand their impact on the patient’s psychological and physical well-being. Researchers have also established that executing these techniques has a negative psychological effect on the staff. (Tölli, 2017). The healthcare facility’s staff may experience ugly emotions such as unnecessary anger, fear, and anxiety due to the consistent implementation of these practices (Mérineau‐Côté, 2014). This contributes to increased staff turnover in the facility, which is very costly (Department of Health, 2017).
A local example
In my practice setting which also is my place of employment, I investigate the prevalence of this practice. The facility’s COO ( Chief Operating Officer) Paula Roberts RN, agreed to talk to me about the practice. According to the COO, the practice is necessary in controlling violent and aggressive behaviors in the facility. However, the COO acknowledges that the practice negatively impacts the experience of patients in the facility. Internal research in the facility found that many young people associated physical restraint and seclusion with punishment. The study also established that a section of the facility’s staff used the practice as a threat to coerce patients to follow their instructions. The study recommended that physical restraints be used only in emergency situations and called for the abolition of seclusion of patients.
As seen above, excessive physical restraint and seclusion have negative physical and psychological impacts on children and adolescents. Therefore, mental healthcare facilities should adopt better and efficient strategies to manage violent behaviors among patients. This includes personnel to anticipate violent activities and prevent them from happening. Caregivers should adopt non-aggressive communication strategies to prevent and respond to violent and aggressive behaviors. They can also use other treatment plans such as behavioral therapy.
Department of Health (2017) Reducing the Need for Restraint and Restrictive Intervention. London: Department of Health Publications.
Mérineau‐Côté, J., & Morin, D. (2014). Restraint and seclusion: The perspective of service users and staff members. Journal of Applied Research in Intellectual Disabilities, 27(5), 447-457.
Tölli, S., Partanen, P., Kontio, R., & Häggman‐Laitila, A. (2017). A quantitative systematic review of the effects of training interventions on enhancing the competence of nursing staff in managing challenging patient behaviour. Journal of Advanced Nursing, 73(12), 2817-2831.