Mental health articles

Rights,risks and responsibilities related to restraint

Guidance from the Royal College of Nursing  gives us the opportunity to open up some discussions about the use of restraint. Issues arise when we try to keep people safe while retaining their independence and maintaining a therapeutic alliance with them. Restraint is an emotive issue for all, and those working with older people need practical solutions, which respond to older people’s complexity.

The premise behind using any form of restraint is that it is a last option when all other therapeutic ways forward have been tried and have failed. Restraint is described as an intervention which prevents a person from behaving in ‘ways that threaten or cause harm, to themselves, others or to property’. Methods of restraint include:  holding back;  confi nement to a chair, using a beanbag as a chair; keeping in bed with bed rails or using a ma ress on the fl oor; keeping in a limited environment, e.g. a ward or room; withdrawal of sensory aids such as glasses; controlling language, non-verbal communication and body language;  medication. Care must be taken when using restraint.

As highlighted by Watson, even in situations where they feel that restraint is justified, staff may actually be abusing the person whether or not they are solving the problem. Restraint can be a symptom of busyness, of inadequate staffing or of the person being in the wrong environment. So, assessment is key in identifying the underlying cause and need for restraint.

Tags: responsibilities, restraint, risks