Mechanical restraint: Legal, ethical and clinical issues

Abstract

The use of mechanical restraint as a means to manage the violent and/or self-injurious behaviour of psychiatric patients remains controversial, due primarily to this practice restricting freedom, and often being implemented against the patients will. The thought of mechanical restraint conjures up cruel and often barbaric interventions, confined to historical ideas about how to treat and manage the mentally ill. With modem advances in psychiatry, particularly in relation to an increased understanding of mental illness, and more effective psychotropic medication, there was hope that interventions of this nature were no longer required. Policies on the use of mechanical restraint vary significantly from country to country and depend greatly, although not consistently, on the prevailing culture and legal framework. Within the United Kingdom (UK), mechanical restraint is relatively uncommon, compared to other countries, and it attracts the highest levels of disapproval of all the containment methods by UK student psychiatric nurses. However, there remains a small group of patients, whose severe mental disorder, combined with "grave and immediate" violence and life-threatening self-injury, has deemed it necessary to consider restrictive interventions of this nature. Within the UK, these patients will most likely reside in "Special Hospitals", which offer high secure hospital accommodation for mentally disordered offenders. Thus, the clinical teams who attempt to treat patients who present with these challenges face an ethical conflict between patients' autonomy and physical and mental integrity on the one hand and the requirement to prevent harm on the other. Within this chapter, we consider the legal, ethical and practical considerations to exploring the implementation of mechanical restraint in a secure psychiatric setting. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)