Physical Restraint, Acute Care Drugs Still Part of Treatment in Mental Health Units

A new Canadian study finds that psychiatric hospital providers continue to use intervention techniques such as physical restraint and confinement.

Although the use of physical restraint has declined in nursing homes, the practice is used in hospitals as clinicians use physical restraints to prevent patient falls, to forestall disruption of therapy, or to control disruptive behavior.

New research suggests the risks of such a practice outweigh the benefits as the intervention can cause harm to both patients and care facilities, according to University of Waterloo researchers.

The study, which appears in a special mental health issue of Healthcare Management Forum, found that almost one in four psychiatric patients in Ontario hospitals are restrained using control interventions. These include chairs that prevent rising, wrist restraints, seclusion rooms or acute control medications.

“The latest findings show that the use of restraints and medications as control interventions is still an everyday practice in inpatient mental health units,” said Dr. John Hirdes, of the Faculty of Applied Health Sciences at Waterloo and senior author on the paper.

The research reveals that Ontario health-care providers administer acute control medication to almost 20 per cent of psychiatric patients in order to manage dangerous situations.

“Control interventions are not ideal because they counter a patient-centered approach to care and can damage therapeutic relationships while further stigmatizing patients,” said Dr. Tina Mah, lead author and vice president of planning, performance management and research at Grand River Hospital.

“There are also organizational implications of control interventions use including increased costs of care, reputational harm and exposure to potential litigation.”

The study suggests that earlier detection of illness or deterioration would help avoid patient crisis and minimize the use of physical restraint, sedation or seclusion. In addition, health-care providers should not use control interventions when a psychiatric emergency is not present.

“Health-care leaders need to pursue more patient-centered approaches to the provision of mental health services. The Mental Health and Addictions Quality Initiative is a positive example of collaboration by hospitals to improve the quality of mental-health services, including in the area of control intervention use,” said Mah.

Source: University of Waterloo