Restraints in Psychiatry

ABSTRACT
Using of seclusion and restraint in psychiatry clinics
Restrictive methods such as seclusion and restraint are used for patients hospitalized in psychiatry clinics in
order to prevent their harmful behaviors against themselves, other patients or hospital employees. The
expected outcome of seclusion is to overcome the threat, and/or to raise patient’s mental health status
to a certain level that he/she can join other patients in the clinic. Seclusion and restraint practice in the
society is affected by the cultural features of that period throughout the history. In this paper, brief history
of seclusion and restraint interventions that come from the early ages to the present day, reasons for these
applications, their indications and contraindications, complications associated with these applications are
reviewed. Moreover, interventions implemented in different countries to reduce the use of seclusion and
restraints are reviewed, and the key elements of successful programs are included. Legal regulations on this
issue and current status in our country are also mentioned.
Key words: Agitation, seclusion, restraint

Psikiyatri kliniklerinde yatarak tedavi gören hastaların kendilerine, diğer hastalara veya hastane çalışanlarına
yönelik zarar verici davranışlarına engel olmak amacıyla yalıtım ve bağlama (tecrit ve tespit) gibi kısıtlayıcı
yöntemler uygulanmaktadır. Yalıtımın beklenen sonucu, tehlikeyi bertaraf etmek ve/veya hastanın ruhsal
durumunun servisteki diğer hastalara katılabilecek kadar ilerlemesini sağlamaktır. Toplumlardaki yalıtım ve
bağlama uygulamaları tarih boyunca dönemin kültürel özelliklerinden etkilenmiştir. Bu yazıda, ilk çağlardan
günümüze kadarki yalıtım ve bağlama olaylarının kısa tarihçesi, uygulamanın gerekçesi, endikasyon ve
kontrendikasyonları, uygulamaya bağlı komplikasyonlar gözden geçirilmiştir. Ayrıca yalıtım ve bağlama
uygulamalarını azaltma girişimleri hakkında farklı ülkelerdeki uygulamalar gözden geçirilerek, başarılı olan
programların öğelerine yer verilmiştir. Konuya ilişkin yasal düzenlemelere ve ülkemizdeki duruma da
değinilmiştir.
Anahtar kelimeler: Ajitasyon, yalıtım, bağlama

The report examines the use of seclusion and restraint across different detention contexts in New Zealand. It is based on visits to seventeen different places of detention including prisons, health and disability units, a youth justice residence, a children’s care and protection residence, and police custody suites, which took place between 26 October 2016 and 11 November 2016. It is also based on material provided before, during and after those visits, including some extensive data sets.
The report was commissioned by the New Zealand Human Rights Commission with funding from the UN Subcommittee on the Prevention of Torture, and conducted by an independent expert, Dr Sharon Shalev, of the Centre for Criminology at the University of Oxford, UK.

Some male interviewees encounter difficulties when they try to express their emotions and overcome anti-feminist positions that transform the research setting into places where hyper-masculinities are reproduced. This research finds that critical dialogue is a persuasive tool interviewers can employ to challenge their participants to empathize with perspectives that contest and confront gendered violence, institutional coercion, and misogyny. Drawing on eight interviews I conducted with male security officers (all former colleagues of the author) who engaged in healthcare violence against male and female psychiatric patients at two hospitals in Ottawa, Canada, I discovered that dissent and the testament of past sufferings inspires people to reconsider their marginalizing standpoints, and helps participants and researchers who have experienced trauma before and during the research process to cope with their emotional suffering and find closure. This approach may encounter ethical problems such as researcher/participant re-victimization and distress, which may be resolved through debriefing exercises, and displays of empathy, compassion, non-judgement, and friendship.

Der von Marietta Meier, Gisela Hürlimann und Brigitta Bernet verfasste Bericht untersucht die 1999/2000 politisch diskutierte Frage, inwiefern und in welchem Ausmass in den psychiatrischen Anstalten Burghölzli (heute PUK) und Rheinau zwischen 1870 und 1970 Zwangssterilisationen und andere Zwangsmassnahmen vorgenommen wurden. Zu diesem Zweck reflektiert die Studie die Geschichte der Psychiatrie und ihrer Reformen (u.a. No Restraint), erarbeitet ein analytisches Instrumentarium, um Zwang, Gewalt und Agency in Institutionen und Gesellschaft zu fassen (informed consent, wie kommen Einwilligungen zustande), verschränkt diese Analyse mit den Kategorien Geschlecht und Schicht wertet ihr Sample aus 1330 Krankenakten nach einem umfassenden Katalog aus disziplinarischen und medizinischen Massnahmen (darunter Kuren, Elektroschockbehandlung, chirurgisches Eingriffe) aus, die intentional oder als Nebeneffekt Zwangselemente aufweisen. Die Studie wurde 2004 mit dem Förderpreis der Deutschen Gesellschaft für die Geschichte der Medizin, Naturwissenschaft und Technik e.V. (DGGMNT) ausgezeichnet.

Au Québec, les mesures de contrôle – isolement, contentions et substances chimiques – font l’objet d’un encadrement législatif depuis 1998. Or, depuis cette date, les substances chimiques sont au coeur d’un débat sur leur statut juridique, entre thérapie et contrôle. En 2015, le ministère de la Santé et des Services Sociaux publie un Cadre de référence révisé sensé établir des normes directrices en matière de substances chimiques utilisées à des fins de contrôle. Un examen de ce cadre laisse pourtant transparaître plusieurs incohérences, entretenant l’indétermination sur leur statut. D’une part, l’exception prévue en matière de consentement ne correspond pas au cadre juridique québécois en matière de soins, laissant penser qu’il s’agit bien d’une mesure de contrôle. D’autre part, les actes réservés sont les mêmes, que les substances chimiques soient utilisées à des fins de contrôle ou à des fins thérapeutiques, laissant penser qu’il s’agit plutôt d’une mesure thérapeutique.

Based on eight in-depth interviews conducted with security guards who work in the psychiatric units of two hospitals located in Ottawa, Canada, this research found that private security agents unknowingly draw on Sykes and Matza’s five techniques of neutralization to justify their use of violence and coercive force against patients and to overcome their feelings of guilt for participating in the administration of brutal intervention practices, including physical and chemical restraints. Guards claimed that these practices benefit the patients more than it hurts them and in cases where they believed the interventions to be unwarranted, guards either accepted the medical staff’s judgment to make decisions about when coercive force should be used or condemned the authority the nursing staff has in determining how to manage patients. They also drew on militant codes of security conduct to justify their tough demeanours and resilient attitudes towards medicalized violence. Implications for forensic practice include considerations of the effects of the (gendered) power relations that structure closed institutional settings and can harm already vulnerable patients, as well as the negative consequences of using security to enforce arbitrary institutional rules.

This article unfolds the culture of hyper-masculinity I witnessed and ultimately rejected during my sixteen-month career working as a private security officer in an Ottawa hospital. I draw on two ethnographic narratives to “distribute”, in Rancièrian terms, the embodied and emotional experiences that accompanied my struggles to achieve hegemonic masculine status, and resist military-like hierarchies inside an institutional setting. Such a creative methodological exercise allows researchers to freely explore their delicate, complex and messy feelings that may otherwise be ethically suppressed or co-opted through less corporeal representations of academic writing. Moreover, by revealing the sensitive and coercive interactions that steered my gendered relationships with psychiatric patients, ward nurses and other security agents, I demonstrate how embodied research can transform our uncritical heteronormative positions on masculinity and violence, as well as contest the unequal, gendered and medicalized judgments that are imposed on incarcerated mental health patients.

Coercion in care relationships is well known to be a forced treatment against the patients. The coercion forms consist of involuntary admission, involuntary treatment, seclusion, physical and mechanical, restraint, forced medication, etc. This study aims to analyze the impact of coercive measure in clinical work, therapeutic and care relationships.

To obtain a database to be used in the effort to reduce the use of restraint in mental health hospitals in Turkey, and to compare the data with results of similar studies. The sociodemographic characteristics, history of violent or suicidal behavior, and BPRS scores of patients restrained during a 1-month period, and data concerning the number of beds and staff working during day and night shifts were collected. The restraint variables, number of restraints used and duration of restraint use, in all wards were determined and adult psychosis wards were compared according to these variables. Approximately 25% (194) of 810 hospitalized patients were restrained for a total of 1524.25 h (mean: 3.25 h) during 1 month. In all, 182 restrained patients were analyzed and most were male, elementary school graduates, never married, and living with first-degree relatives. There were no correlations between these variables, and the number of restraints used and the duration of their use. Mean age...

Fuite, agitation, provocation, insultes et violences physiques constituent le quotidien des pratiques en itep pour adolescents. Cet article propose d’interroger les modalites de reponses physiques operees parfois par les professionnels pour tenter de contenir par le corps ce qui ne peut etre contenu emotionnellement ou psychiquement par les adolescents. L’auteur montre, en appui sur la litterature actuelle sur le sujet et sur des etudes de cas cliniques, en quoi la contention physique, des lors qu’elle devient trop recurrente, voire systematisee, risque d’etre entendue comme une retorsion envers les troubles adolescents.

To obtain a database to be used in the effort to reduce the use of restraint in mental health hospitals in Turkey, and to compare the data with results of similar studies. The sociodemographic characteristics, history of violent or suicidal behavior, and BPRS scores of patients restrained during a 1-month period, and data concerning the number of beds and staff working during day and night shifts were collected. The restraint variables, number of restraints used and duration of restraint use, in all wards were determined and adult psychosis wards were compared according to these variables. Approximately 25% (194) of 810 hospitalized patients were restrained for a total of 1524.25 h (mean: 3.25 h) during 1 month. In all, 182 restrained patients were analyzed and most were male, elementary school graduates, never married, and living with first-degree relatives. There were no correlations between these variables, and the number of restraints used and the duration of their use. Mean age...

Fuite, agitation, provocation, insultes et violences physiques constituent le quotidien des pratiques en itep pour adolescents. Cet article propose d’interroger les modalités de réponses physiques opérées parfois par les professionnels pour tenter de contenir par le corps ce qui ne peut être contenu émotionnellement ou psychiquement par les adolescents. L’auteur montre, en appui sur la littérature actuelle sur le sujet et sur des études de cas cliniques, en quoi la contention physique, dès lors qu’elle devient trop récurrente, voire systématisée, risque d’être entendue comme une rétorsion envers les troubles adolescents.

English
Pandemonium, Violences and Restraints: Teenagers’Everyday Life in Therapeutic and Educational Institutions

Escape, turmoil, provocation, insults and physical violence constitute the daily practice of adolescent therapeutic and educational institutions. This article questions the modalities of physical responses sometimes delivered by the professionals trying to contain through the body what cannot be emotionally or mentally withheld by teenagers. Based upon current literature on the subject and clinical case studies, the author demonstrates how physical restraint, when too frequent or systematic, may be understood as a retaliation for adolescent disorders.