by Grant J Everett
Restraining people against their will is something to be avoided wherever possible. There are some cases where people consider that restraint is needed to protect people from danger as a last resort. Many of us, however, consider that restraint should be used far less often or not at all in the mental health units of hospitals.
Sarah Hughes from the United Kingdom shared some ideas which may encourage people to consider alternative approaches that may keep people safe without using force.
Firstly, what exactly do we mean by restraint? There are a number of different types. The least obvious is ‘chemical’ restraint’. This is where a person is injected with a drug against their will with the intention of making them more ‘sedate.’ Then there are various forms of mechanical restraint which involve restricting people from moving their arms and legs or putting them in a seclusion room.
Sarah Hughes, Chief Executive Officer of the Centre for Mental Health in the United Kingdom, had a very encouraging story to share about alternatives when she spoke at the TheMHS (Mental Health Services) Summer Conference in February 2017.
Sarah used to work at a mental health unit that was able to slash its use of mechanical restraint from several times a day to ZERO over a short time. They did this with the best solution to all problems: prevention.
Sarah worked at a very volatile unit, and her fellow staff members restrained people who showed aggressive behaviour a lot. For some of the residents, mechanical restraint had become a daily occurrence. This understandably caused a lot of tension, stress and bad feelings all around. It is hard to regain the trust of a person after you’ve strapped them down and injected them against their will. This causes a snowballing effect which makes the problems become larger and larger.
“Mechanical restraint is bad for everyone” Sarah told the conference: “it’s inhumane for the patients, and it poses an injury risk to the staff members. Trying to hold down somebody who’s “going off” is a good way to get punched in the face or break a finger.”
Having to hold the same people down day after day was about as far from ideal as you can get both for staff and patients. So some of the staff members decided that enough was enough: it was time to do something different to end this spiral.
Logically, preventing a bad situation from forming in the first place is always far more effective than de-escalating a bad situation once it has already begun. So the staff members knew the solution must lay in somehow stopping things from hitting boiling point to begin with.
They decided to test out a novel, yet simple tactic: focusing on how they woke the people up in the morning.
Like mental health units in general, there was a set time for the residents to start their day, and every single morning the staff would do the rounds, banging on all the bedroom doors shouting “Medication!”
If you wanted somebody to start the day grumpy, yelling at them would be highly effective. So, rather than giving the patients a rude awakening, the plan was for the nurses to rouse them in a more gentle way by bringing around a hot cup of coffee or tea.
The logic behind this was to try to start the day fresh, on a good note, with no baggage carried over.
Some of the staff members, however, were highly resistant to this idea, citing that they “weren’t running a bed and breakfast service.” The psychiatrist in charge of the unit decided to give this technique a go, and it worked brilliantly.
This tiny change had a massive impact, and the incidence of mechanical restraint in that ward each day quickly went down to zero. This had a lasting effect on the dynamics of that unit.
“Compassion needs to be at the very core of dealing with people who are in distress” said Sarah. “We need to find what the people who access our services love, live for, and get out of bed in the morning for.”
Sarah Hughes is the CEO of the Centre for Mental Health in the UK. She says she ‘has lots of mental’ health issues in her family, which has served to fuel her career. Initially trained as a social worker, Sarah has worked in mental health and criminal justice for the last 25 years. She has managed a range of innovative community and secure services in the United Kingdom, most recently at Mind in Cambridgeshire, known for high impact campaigns including ‘Stop Suicide’ and ‘StressLess.’ She also led the research and evaluation of a pioneering ‘First Night in Custody’ project in a prison .