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Physical restraint refers to means of purposely limiting or obstructing the freedom of a person's bodily movement.
Usually, binding objects such as handcuffs, legcuffs, ropes, chains, straps or straitjackets are used for this purpose. Alternatively different kinds of arm locks deriving from unarmed combat methods or martial arts are frequently used to restrain a person, which are predominantly used by trained police or correctional officers. This less commonly also extends to joint locks and pinning techniques.
British Police officers are authorised to use leg and arm restraints, if they have been instructed in their use. Guidelines set out by the Association of Chief Police Officers dictate that restraints are only to be used on subjects who are violent while being transported, restraining the use of their arms and legs, minimising the risk of punching and kicking. Pouches carrying restraints are usually carried on the duty belt, and in some cases carried in police vans.
Physical restraints are used:
Restraining someone against their will is generally a crime in most jurisdictions, unless it is explicitly sanctioned by law. (See false arrest, false imprisonment).
The misuse of physical restraint has resulted in many deaths. Physical restraint can be dangerous, sometimes in unexpected ways. Examples include:
For these and many other reasons, extreme caution is needed in the use of physical restraint.
Gagging a restrained person is highly risky, as it involves a substantial risk of asphyxia, both from the gag itself, and also from choking or vomiting and being unable to clear the airway. In practice, simple gags do not restrict communication much; however, this means that gags that are effective enough to prevent communication are generally also potentially effective at restricting breathing. Gags that prevent communication may also prevent the communication of distress that might otherwise prevent injury.[ citation needed ]
A survey in the US in 1998 reported an estimated 150 restraint related deaths in care environments (Weiss, 1998). Low frequency fatalities occur with some degree of regularity. [2] An investigation of 45 restraint related deaths in US childcare settings showed 28 of these deaths were reported to have occurred in the prone position. [2] In the UK restraint related deaths would appear to be reported less often. The evidence for effective staff training in the use of medical restraints is at best crude, [3] with evaluation of training programmes being the exception rather than the rule. [4] Vast numbers of care staff are trained in 'physical interventions' including physical restraint, although they rarely employ them in practice. It is accepted that staff training in physical interventions can increase carer confidence. [5]
Japanese law states that psychiatric hospitals may use restraints on patients only if there is a danger that the patients will harm themselves. The law also states that a designated psychiatrist must approve the use of restraints and examine the patient at least every 12 hours to determine whether the situation has changed and the patient should be removed from restraints. [6] However, in practice, Japanese psychiatric hospitals use restraints fairly often and for long periods. Despite being required to certify every 12 hours whether a patient still needs restraints, Japanese psychiatric hospitals keep patients in restraints for a much longer time than hospitals in other countries. According to a survey conducted on 689 patients in 11 psychiatric hospitals in Japan, the average time spent in physical restraints is 96 days. [7] Meanwhile, the average time in most other developed countries is at most several hours to tens of hours.
The number of people who are physically restrained in Japanese psychiatric hospitals continues to increase. In 2014 more than 10,000 people were restrained-the highest ever recorded, and more than double the number a decade earlier. [8] It is thought that some of that increase includes older patients with dementia. As a result, the Japanese Ministry of Health, Labour and Welfare has revised its guidelines for elderly people in nursing homes to have more restrictions against body restraints. The changes will take effect on 1 April 2018. [9]
Deaths have been reported from their use, including that of Kelly Savage, an Assisted Language Teacher from New Zealand, in 2017. [10] [11] [12] [13]
The Millfields Charter is an electronic charter which promotes an end to the teaching to frontline healthcare staff of all prone (face down) restraint holds. [14] In June 2013 the UK government announced that it was considering a ban on the use of face-down restraint in English mental health hospitals. [15]
Face down restraints are used more often on women and girls than on men. 51 out of 58 mental health trusts use restraints unnecessarily when other techniques would work. Organisations opposed to restraints include Mind and Rethink Mental Illness. YoungMinds and Agenda claim restraints are "frightening and humiliating" and "re-traumatises" patients especially women and girls who have previously been victims of physical and/or sexual abuse. The charities sent an open letter to health secretary, Jeremy Hunt showing evidence from 'Agenda, the alliance for women and girls at risk', revealing that patients are routinely restrained in some mental health units while others use non-physical ways to calm patients or stop self-harm. According to the letter over half of women with psychiatric problems have suffered abuse, restraint can cause physical harm, can frighten and humiliate the victim. Restraint, specially face down restraint can re-traumatise patients who previously suffered violence and abuse. "Mental health units are meant to be caring, therapeutic environments, for people feeling at their most vulnerable, not places where physical force is routine".
Government guidelines state that face down restraint should not be used at all and other types of physical restraint are only for last resort. Research by Agenda found one fifth of women and girl patients in mental health units had suffered physical restraint. Some trusts averaged over twelve face down restraints per female patient. Over 6% of women, close to 2,000 were restrained face-down in total more than 4,000 times. The figures vary widely between regions.
Some trusts hardly use restraints, others use them routinely. A woman patient was in several hospitals and units at times for a decade with mental health issues, she said in some units she suffered restraints two or three times daily. Katharine Sacks-Jones director of Agenda, maintains trusts use restraint when alternatives would work. Sacks-Jones maintains women her group speak to repeatedly describe face down restraint as a traumatic experience. On occasions male nurses have used it when a woman did not want her medication. "If you are a woman who has been sexually or physically abused, and mental health problems in women often have close links to violence and abuse, then a safer environment has to be just that: safe and not a re-traumatising experience. (...) Face-down restraint hurts, it is dangerous, and there are some big questions around why it is used more on women than men". [16] The use of restraints in UK psychiatric facilities is increasing. [17]
Psychiatric hospitals, also known as mental health hospitals or behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, including schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder, and others.
The David Bennett Inquiry was held in the UK to look into the death of David "Rocky" Bennett on 30 October 1998 in a medium secure psychiatric unit in Norwich, after being restrained by staff.
Medical restraints are physical restraints used during certain medical procedures to restrain patients with (supposedly) the minimum of discomfort and pain and to prevent them from injuring themselves or others.
Suicide watch is an intensive monitoring process used to ensure that any person cannot attempt suicide. Usually the term is used in reference to inmates or patients in a prison, hospital, psychiatric hospital or military base. People are placed on suicide watch when it is believed that they exhibit warning signs indicating that they may be at risk of committing bodily harm or purposefully killing themselves.
Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors.
Deinstitutionalisation is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late 20th century, it led to the closure of many psychiatric hospitals, as patients were increasingly cared for at home, in halfway houses and clinics, in regular hospitals, or not at all.
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.
Pine Rest Christian Mental Health Services is a psychiatric hospital and behavioral health provider, with the main treatment campus located in Gaines Township, Michigan. The Chief Executive Officer and President is Dr. Mark Eastburg, appointed December, 2006.
The Judge Rotenberg Center (JRC) is a controversial institution in Canton, Massachusetts, United States, for people with developmental disabilities and emotional and behavioral disorders. The center has been condemned for torture by the United Nations special rapporteur on torture. The JRC is known for its use of the graduated electronic decelerator (GED), a device that administers electric shocks to residents as part of the institution's behavior modification program.
Disability Rights International (DRI), formerly Mental Disability Rights International, is a Washington, DC–based human rights advocacy organization dedicated to promoting the human rights and full participation in society of persons with disabilities worldwide. DRI documents conditions, publishes reports, and promotes international oversight of the rights of persons with disabilities.
The Virginia Department of Behavioral Health and Developmental Services (DBHDS) is a state agency of the Commonwealth of Virginia. The department operates Virginia's public mental health, intellectual disability and substance abuse services system through a system of 40 locally and regionally run community services boards (CSBs) and which serve children and adults who have or who are at risk of mental illness, serious emotional disturbance, intellectual disability, or substance use disorders.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, and perceptions.
Bridgewater State Hospital, located in southeastern Massachusetts, is a state facility housing the criminally insane and those whose sanity is being evaluated for the criminal justice system. It was established in 1855 as an almshouse. It was then used as a workhouse for inmates with short sentences who worked the surrounding farmland. It was later rebuilt in the 1880s and again in 1974. As of January 6, 2020 there were 217 inmates in general population beds. The facility was the subject of the 1967 documentary Titicut Follies. Bridgewater State Hospital falls under the jurisdiction of the Massachusetts Department of Correction but its day to day operations is managed by Wellpath, a contracted vendor.
The lunatic asylum, insane asylum or mental asylum was an early precursor of the modern psychiatric hospital.
Patient abuse or patient neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient. Elder abuse is classified as patient abuse of those older than 60 and forms a large proportion of patient abuse.
A restraint chair is a type of physical restraint that is used to force an individual to remain seated in one place to prevent injury and harm to themselves or others. They are commonly used in prisons for violent inmates and hospitals for out of control patients. However, they have also been used to restrain prisoners at Guantanamo Bay detention camp during force-feeding.
The Keeping All Students Safe Act or KASSA is designed to protect children from the abuse of restraint and seclusion in school. The first Congressional bill was introduced in the United States House of Representatives on December 9, 2007, and named the Preventing Harmful Restraint and Seclusion in Schools Act. The primary sponsors of the two bills are Senator Tom Harkin (D-IA), Chair of the Senate Health, Education, Labor, and Pensions Committee, Congressman George Miller (D-CA), Ranking Member of the House Education and Workforce Committee, and Congressman Gregg Harper (R-MS).
Mental health in the United Kingdom involves state, private and community sector intervention in mental health issues. One of the first countries to build asylums, the United Kingdom was also one of the first countries to turn away from them as the primary mode of treatment for the mentally ill. The 1960s onwards saw a shift towards Care in the Community, which is a form of deinstitutionalisation. The majority of mental health care is now provided by the National Health Service (NHS), assisted by the private and the voluntary sectors.
Kelly Robert Savage was an Assistant Language Teacher in Japan whose death sparked an international outcry and a national debate in Japan about their psychiatric system and its use of long-term physical restraints. Savage was a dual citizen of New Zealand and the United States, and worked in Shibushi, Kagoshima in Japan from August 2015 until his death in May 2017.
Olaseni Lewis, a 23-year-old British man, died on 3 September 2010 at Bethlem Royal Hospital in London, United Kingdom, after police subjected him to prolonged physical restraint. Lewis had voluntarily sought care following the onset of acute mental health issues and died from cerebral hypoxia soon after, following actions that involved eleven officers of London's Metropolitan Police. After seven years of campaigning by Lewis' family and two inquiries by the Independent Police Complaints Commission (IPCC), a second coroners' inquiry was raised.
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