Warning on physical restraint in mental care

  • Niall Hunter, Editor

Seclusion and restraint should be used in mental health care only in exceptional circumstances and only in the best interests of patients if they pose an immediate threat of serious harm to themselves or others.

This is according to the mental health care regulator, the Mental Health Commission (MHC).

A new MHC report shows that two centres - St Joseph's Intellectual Disability Services in Portrane, Co. Dublin and St Brendan's Hospital in Grangegorman, Dublin - accounted for more than half of all seclusion episodes in 2010.

However, the MHC said some approved centres which record high numbers of restrictive interventions often manage more challenging behaviour than in other approved centres.

"St Brendan's serves as a secure unit for the greater Dublin area for example. It is also important to look at the duration of episodes of restrictive intervention," the MHC added.

While St Joseph's Intellectual Disability Services recorded the highest number of seclusion episodes, almost all seclusion incidents there lasted less than four hours, which was typically less than in other centres.

Of the three restrictive interventions - seclusion, mechanical restraint and physical restraint reported to the Commission, physical restraint continues to be the most frequent one used.

"In total there were 5,370 restrictive intervention episodes recorded during 2010 compared to 5,387 in 2009. In 2010, there were 2,985 physical restraint episodes, 2,371 seclusion episodes and 14 mechanical restraint episodes," the MHC said.

There was a decrease of 146 in the number of seclusion episodes between 2009 and 2010, and the number of physical restraint episodes increased by 130 from 2009 to 2010. it added.

"Mechanical restraint is rarely used in approved centres and accounts for 0.3% of all restrictive interventions reported to the Commission."

Forty-three restraint episodes lasted for longer than 30 minutes in 2010 compared to 98 episodes that lasted for longer than 30 minutes in 2009.

Four episodes lasted for more than one hour which was substantially less than the 42 episodes of physical restraint that lasted for longer than one hour in 2009, the MHC said.

The decline in the duration of physical restraint was welcomed by the Commission, "Reducing the time a patient spends restrained is very much welcomed. It is the Commission's view that the use of seclusion and restraint should be minimised as much as possible."




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