Restraint And Confinement: Still In Use For Psychiatric Patients

Expert says health-care pioneers need to pursue more patient-centered approaches in areas of mental health services.

A study published recently in the special mental health issue of Healthcare Management Forum indicated that mental-health services and providers still used unethical intervention techniques – physical restraints and confinement – to control patients enrolled in psychiatric hospitals. Researchers from the University of Waterloo claimed these methods could potentially harm both, the facility and the patient.

What Study Revealed

A survey of the hospitals of Ontario revealed that almost one out of every four psychiatric patients was restrained using control interventions. This included chairs that inhibit movement, binding of the wrists and seclusion rooms. Researchers also found that health-care providers at these hospitals administered sensitive control medications to about 20 percent of psychiatric patients to avoid any dangerous situations.

The study reported that impediments in transferring psychiatric patients from hospitals to other health-care settings amount to approximately $7,650 per patients in expenditure to the government. Moreover, after controlling other variables, Francophone Ontarians were found to be one third as likely to come into daily contact with patients as compared to English-speaking ones.

Expert Viewpoint

Tina Mah is the Vice President of Planning, Performance Management and Research at the Grand River Hospital and is the lead author of the study as well. She says that control measures such as these are not the ideal form of intervention, since they oppose the more caring and empathetic patient-centered approach. She added that the use of such forceful techniques damages the therapeutic relationship and trust between the patient and health-care provider and increases the trauma and torment of the patient.

Mah also said that the use of control interventions is also harmful for the institution, in terms of reputational harm, increased cost of care and potential legal action.

Suggestions For Alternatives And Improvements  

Researchers suggest that an earlier detection of mental decline or illness could save patients from extreme control measures and minimize the use of restraint, isolation and sedation. More importantly, unless there is emergency, health-care providers should not employ drastic control interventions.

“Health-care pioneers need to pursue more patient-centered approaches in the areas of mental health services. The Mental Health and Addictions Quality Initiative is a positive example of collaboration between hospitals for improving the quality of mental-health services, including the use of control interventions,” commented Mah.

“While reducing expenditures is a priority in the present health-care scenario, heath-care leaders need to be aware of the importance of making mental-health services equally accessible for all Canadians and protecting our most vulnerable citizens,” added Professor Hirdes from the Faculty of Applied Health Sciences at Waterloo who is also a senior author of the study.

InterRAI Canada

Professor Hirdes also heads an international research network known as ‘interRAI Canada’ that develops tools for the assessment of mental health. In 2005, the government made it mandatory for all hospitals in Ontario to complete the mental health assessment given by interRAI Canada. This applied to all adult patients enrolled in psychiatric settings. These assessments could assist health-care workers in obtaining a detailed overview of various factors associated with mental health to formulate steps for the development of better health-care plans in terms of patient’s needs and preferences.

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