Should Restraints in Psychiatric Care Be Illegal?

Should restraints in psychiatric care be illegal?

Posted Aug 29, 2011

When one of Canada's leading public health journalist, Andre Picard wanted to talk to me for an article in the Globe and Mail about my personal experience with restraints, I was honoured. Honoured and nervous. It's a touchy subject.

And then he explained that a new study reveals "One in every four psychiatric patients who is hospitalized is subdued using ‘methods of last resort,' such as mechanical restraints or fast-acting sedatives, a new study shows." This opener took me off guard. Why? Because I am one of those four patients.

I was even more motivated to write about this topic after reading author and advocate, Susan Inman's compelling National Post article on ‘involuntary treatment' entitled ‘The Right To Be Sane'.

Restraints, that's the technical, polite, less uncomfortable term for being strapped to a gurney or getting a good shot of some kind of medication (usually in your butt) or just plain old being ‘hugged and held' by police or hospital staff, of which I have experienced all three. Now wait before you think I'm gonna let loose with an all out ‘anti-psychiatry, anti-restraint' rant. Hold onto your hospital leather cuffs for just a minute. This issue is not black and white.

Understandably this is a very sensitive issue. Some of us with mental illness have been at the hands of well meaning but not well informed health providers who administer restraints inappropriately and behave in an appallingly patriarchal and disrespectful ways.

On three occasions I experienced all three varieties of restraints. That's right there's three. I didn't know they were categorized into three groups until I spoke to Mr. Picard for his article. Those three types are: physical, chemical and mechanical. I thought all restraints were physical, which in essence they are. They physically incapacitate us. But in the world of psychiatric medicine they make further distinctions.

Physical: being physically restrained (i.e.: held down, held back, prevented from moving) by a person or person(s).

Chemical: No, that doesn't mean pepper spray or napalm, although it sounds just as terrible. Chemical restraints, also described as ‘acute control medications', are the fast acting sedatives or anti-psychotics to help a person get out of a psychotic episode. And I use that word ‘help' deliberately.

Mechanical: To me, this is the worst sounding term of all three. As I discussed my experiences with Mr. Picard, I thought: ‘well, I've never undergone mechanical restraints.' I somehow pictured chains or metal shackles. But I have experience the mechanical kind. Those are those oh so fashionable leather cuffs they use to secure you to a bed or gurney - not be confused with other leather accessories.

Mr. Picard cites ‘restraints are used principally to prevent patients from harming themselves, and, secondarily, to keep them from harming others.' But that doesn't take away the fact that it's still horribly heartbreaking to watch someone be restrained. That being said - restraints are not always inappropriate.

When I was in a florid psychosis, my father managed to get me to emergency where, at the time, I was running around a on a parking level incoherent and for all my father knew ready to propel myself into flight off the parking lot roof or onto the street without regard for traffic or my life. Once he resourcefully coaxed me through hospital sliding doors, what other option did staff have? I was out of out of control and had no insight into my behaviour.

In my ideal, if not surreal world, an option would be a place created especially and only for people going through acute psychosis. A setting (perhaps an open empty room with no stimuli, or an open field with soft ground) where one could, with round the clock supervision safely let the psychosis burn itself out on its own over a period of time. The only ‘restraint' that of the kind, well trained mental health professional as a constant companion ensuring safety.

But I have no idea if psychoses can burn themselves out. And I don't know if a psychosis if allowed to continue unfettered if it is worse than receiving a dose of a heavy sedative. All I do know is that I was physically and emotionally burnt out after this particular 24 hour psychosis.

At the time I know that the hospital, the restraints, the Haldol, and the commitment to the psych ward were the best thing for me.

However, the manner in which it occurred could have been markedly better. As I ran around the emerg looking for scissors to cut out my ego, I remember overhearing a hospital staff member call out: ‘Hey! Catch the crazy woman!' Like I said to Mr. Picard: ‘I'm may be crazy, but I am not deaf' (no offense to those who are deaf).

Being committed to the psych ward was really the only and therefore best option at the time. Only in hindsight do I recognize this and that it must have been a devastating choice for my father to make. Now years later, I know he did the right thing.

©2011 Victoria Maxwell