First of all my apologies for the audacity of writing a post in English.
The reason why I write today in English is to make it easier for all those people who visit the blog from non-Spanish-speaking countries. And very especially to Nia for the interest that she has always shown in the topics that I deal within this blog.
In the last few days I have published several posts about mechanical restraints, rather than against the use of mechanical restraints in the social and health field. The big question that we all ask ourselves when we talk about not using restraints is what to do in the case of a situation in which they are usually used: such as an extreme episode of psychomotor agitation. I will leave the answer to this question for last, before I think it is necessary to make some clarifications.
Why we should not use mechanical restraints.
First of all, and it’s the most important reason, it’s because people don’t want to be tied up. This answer would already be important enough to force health professionals to find alternatives to the use of restraints.
Secondly, we find that from different areas the elimination of mechanical restraints is advocated because it collides directly with article 5 of human rights. Institutions such as the World Health Organization, NGOs such as Amnesty International and many patient and family associations denounce the use of mechanical restraints and advocate the search for alternatives.
And although we could find many more reasons, thirdly I would like to point out that there are already places in the world where either mechanical restraints are prohibited or where to take care has been achieved without the use of straps. In my environment, for example, we have managed to reduce the use of restraints, in 2021, by more than 50%.
The key to fighting mechanical restraints. Before analyzing what to do when a person reaches a complex situation with a risk of self/heteroaggressiveness, I think it is timely to focus on several key aspects.
1) Change our attitude towards restraints, recognize that it is possible to take care without restraints and learn/copy from people and environments that have advanced in this field.
2) Radically change the physical environments and the norms/rules of mental health units to make them more friendly, comfortable and serve to reduce patient stress and promote a therapeutic environment.
3) Complete training plan on ethical and theoretical aspects, favoring a therapeutic environment, alternatives to restraints, management of psychomotor agitation, etc.
4) Unconditional support from the management and directors of the centers to promote change in both human and material resources, as well as support in clinical protocols.
Both what the evidence on this subject indicates and my personal experience, I can assure you that with just these 4 points you can make a lot of progress towards zero mechanical restraint.
And if we have done everything humanly possible and, even so, the person has reached a point of agitation or a significant risk of self/heteroaggressiveness, we arrive at the initial question…
What can we do to avoid mechanical restraint?
Well, I think that the most reasonable response is to act as we would do with any patient who did not have a psychiatric diagnosis, that is, respect their wishes and do what, within our possibilities, respects the patient’s wishes.
The alternatives in these moments of crisis can be respectful of the patient, such as accompaniment, waiting, voluntary medication, time-out spaces… or they can also be coercive, such as isolation or forced medication. In any case, it is the person who has to decide what their preference is through informed consent, advance directives or the election of a representative who decides for them.
Unfortunately, the problem of mechanical restraints is not only in mental health units. At least in Spain they are carried out in nursing homes, emergencies, ICUs and hospitalization units in general.
I hope this post makes sense as a whole and helps raise awareness against the use of mechanical restraints. As always, I will be delighted if you share your experiences, doubts and opinions on the blog.
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Escucha «Café para Tres» el Episodio 7 de nuestro podcast «El Cuidado en la palabra»
El cuidado en la palabra 
Dear José, Thank you so much, I have seen now and read. But I will read again tomorrow or weekend. You are so nice, I will come back here again. Good night and have a nice weekend, Love, nia
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Thank you very much dear Nia and if you find something in the text that doesn’t make sense, please, let me know. Good night and happy weekend. With love, JM
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Dear José, once again I should say Thank you, this is really very important subject in this field. And I am sure not only in your country, in the other countries too, especially if we talk about modern 21st humanities … You know, the differences between countries, this could be another subject too.
I am interested in psychology and its fields, etc. Maybe, if I can dare to share my own story I want to write… Not easy subject for me. But I am sure you can understand more than anyone.
On the other hand, as I explained several times, I like to read your posts, subjects… Your humane approaches in every article in your blog, being impressive, important, and yes, sometimes being what we need too hear or to know…
But in here, really something hit me. “Mechanical restraints”… to be against of this ,it brings, (should bring) another way or alternatives too. In a moment made me scared.
You explained very well. I can understand them all now. But I think this is very new in this field. Isn’t it? All countries, do they have this new approaches… Last night I made a short search for my own country. I noticed some of PDF files of some of universities… They explain what is “mechanical restraints” and even “chemical restraints”… But I couldn’t find any information on application areas. They should be in hospitals files, procedures, etc. Anyway, I don’t know right now what is being on here.
“Why we should not use mechanical restraints.” After reading and understanding the logical and necessary reasons of this question, of course, the next question comes, so what? What will be in stead of them? there seem to be still questions/ reservations at that point,… I think that’s a very fine point, of course I am just talking about mental illness… Not other situations.
Do you know dear José, I have a story that I wrote several years ago. Coming from archeological stories/events, finds… I think I should translate it. For you. It hasn’t been published yet in any place. When I translate it, I will send it to you.
This archeological story and today’s your article… just showing me from where we did come to here, today’s realities.. The big journey of humanity.
And also there are many pictures in our minds, even from these days too. Especially television series, and films… we can see the mechanical restraints…
You are doing great job dear José, and I can guess not easy field where you work. There are words in my mind for a few days, and I repeate them, in whispering to my thoughts… I am still writing (as a writer) in my mind… what ever you are, I mean what every is your job, the most important thing is your humanity! Means to be a good, kind and nice person… This should be the essence of your everything… You might be a taxi driver, or a doctor, or a lawyer,… but in the essence of them to be a good human.
I hope and wish that all these efforts will lead you to a better place,… this must be the light within experiences and sharing?
I also hope you don’t mind if I send my own story and also archeological story to you(e-mail), dear José?
Thank you, Love, nia
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Dear Nia, first of all, thank you very much for this extensive comment and with so many interesting subjects and, of course, for your kind words towards me.
From the scientific literature we can know that mechanical restraints are present in most countries, although there are no standardized tools to know how much or how.
In Spain we have the social movement «Zero mechanical containment» although I prefer to say «Towards zero mechanical containment» because, unfortunately, many units and socio-sanitary centers are not prepared to eliminate them, but yes, all of them, to reduce them a lot.
I am absolutely convinced that both for me, as for any reader, your novel about archeology as well as your experiences or anything you write, dear Nia, it will be a pleasure to read.
Regarding mechanical restraints, although I am convinced that a day will come when we will know how to take care of people without them, but I am not a fundamentalist. If I find myself in a situation where I don’t know or can do something else, I would have to do it with great regret.
I will be delighted to read your story. I’m sure if you send it to a publisher they will be very interested in it. And thank you so much again for your kind words. A big hug!!!
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