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.
Escucha «Café para Tres» el Episodio 7 de nuestro podcast «El Cuidado en la palabra»