Impact Of Restraint-based Practices In Mental Health Care On Patients: Essay On Alternative Approaches.

Types of restraints applied in psychological settings

Mental health patients have diverse needs, and their care programs require special attention. Many patients with mental health disorders abstain and resist from receiving care (Gone et al., 2021). This resistance may impact the process of care and may also impose a risk of harm on themselves or on the individuals around them. To contain the same, restraint based control may be imposed on the patients as an "emergency intervention" to ensure the safety and well-being of the individuals (Hamm, 2021). However, the application of restraint is discouraged in mental health care and support. This is paper will discuss how restraint based practices how they impact the process of care and the relationship between the patients and the care service providers. This discussion will also summarise the alternative approaches that can be applied in the process of care to manage the violence and resistance of patients in the process of care. Further, this paper will also summarise the policies and guidelines developed by the Government of Australia that address the restraint based practices in the process of care.

Restraint in the mental healthcare services was developed historically with limited understanding of mental health in the patients (Seppänen et al., 2018). The mental health and psychology of the patients are poorly understood and have been associated with taboo in society. This resulted in the development of stigma against mental health and resulted in the development of restraint for the management of psychological disorders (Da Silva et al., 2020). However, with the advancement of science and improved understanding of mental health disorders, this understanding has changed significantly. Yet, even today, the application of restraint based interventions is done in severe conditions when a threat is perceived and is often discouraged in care facilities (Ye et al., 2019). Mainly, there are three types of restraints that are applied in the psychological settings of inpatient care facilities. These include chemical, physical, and environmental restraint. The physical restraint controls the movement of the patient. The chemicals restraints are used as psychoactive compounds for management the of severe mental health episodes. Whereas environmental restraints are associated with the prevention of free movement of a person from a building or a specific area (Valery & Prouteau, 2020).

The use of restraint based interventions raises a lot of ethical concerns and also raises concerns regarding the conservation of rights of patients with mental health disabilities. One of the prominent ethical principles of care is autonomy (Chou & Tseng, 2020). The principle directs that every patient has the right to accept or reject the treatment in the process of care. This principle is not applied when providing treatment to patients with psychological problems as it is deemed that the patients with mental health complications are not suitable to take complex decisions, and hence, their autonomy regarding medical decisions is restricted in such practice.

The application of restrictive practices in the management of patients with mental health complications is also associated with a poor impact on patients, their families, and also on the care service providers. The foundation of healthy mental health nursing is a strong nurse and patient relationship that is built on trust and mutual rapport. However, when the restriction is applied in the process, this relationship is hindered. This impacts the overall process of care and recovery (National Mental Health Commission, 2019). The family of an individual with mental health complications is also impacted by the application of restrictive interventions where the relationship between the individual and the family member is impacted (da Silva et al., 2020). Moreover, the care workers are also impacted by the application of restrictive practices. There is an increased risk of facing violence by the care workers as the interventions, in many cases, are applied against the will of mental health patients (Kohrt et al., 2020). The application of restrictive practices in mental health is associated with reducing the risk of harm. This can include the application of means of coercion, discipline, retaliation by the staff, and convenience. The application of restrictive practices in mental health care of the patients is associated with limited scientific evidence and is thus often discouraged. This is discouraged because it is associated with physical as well as psychological harm to the patients. It also results in damage to the therapeutic relationship with the patients and is regarded as a violation of human rights (Seppänen et al., 2018). The discouragement of the use of restrictive practices is also associated with the imposition of limitations on the ability of an individual to exercise their freedom and their rights and thus raises questions on its application in terms of the ethical and legal rights of the patients as well as on the patient dignity and sense of self (Valery & Prouteau, 2020).

Ethical concerns and impact on patients, families, and care providers

It is important to acknowledge and understand the dignity of an individual with mental health problems to ensure the provision of suitable care. The discourse of safety around mental healthcare for inpatient services has been institutionalised in the modern nursing practice (Selmon et al., 2017). The same has been asserted and has been taken into consideration with the development of policy structures and guidelines that have been developed by the government of Australia (Muir?Cochrane et al., 2018). The purpose of these policies and guidelines is to ensure that the application of restraint based services is not exploited in the inpatient care facilities of mental health patients and their rights are respected. The government of Australia identifies restraint and seclusion as not-effective treatments and approaches for the management of mental health patients and permits its application in care facilities only in the cases of extensive emergencies. The government asserts that the focus should be on "minimising, and where possible to eliminate" the use of seclusion and restraint based activities (Ross, 2018). The guiding principle of Section 7 of the Mental Health Act 2009 has set the guiding principles for the care facilities to take suitable decisions regarding the care of patients and for the inpatient service for patients with mental healthcare needs (Government of Australia, 2021). According to these guidelines, mental health services have to ensure that they apply the best therapeutic outcomes and focus on recovery by promoting the active participation of patients in community life. In addition, the patients should be given support and a choice as far as possible for the voluntary basis of care that is least restrictive in nature and is in contingency with efficacy and public safety. Further, it is suggested that the treatment is governed by the care plan with minimum invasion and the rights of the patients (Boulton et al., 2022).

To minimise the use of restrictive practices, it is suggested that the prevention strategies are implemented so that the care is minimised. Further, it is also suggested that the patient is involved in the process of care with consideration and active participation of members of the family of the patient (Boulton et al., 2022). This will ensure holistic care and promote an improved scope of recovery for the patients. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has also identified that the application of restraint and seclusion based interventions are traumatising for the patients and thus should be minimised and, when possible, eliminated (Bloch et al., 2018). Further, the application of restraint or seclusion should not be used as a punishment or a measure to control the behaviour of the patients. The purpose of these policies and the guidelines is to ensure improved care outcomes for the patients and provision of care with conservation of their rights and dignity with a humanistic approach towards care (Roberts et al., 2018).

Restriction, restraint and seclusion are defined as the last resort of containing measures in a psychological care facility and are applied to contain the risk of violence from patients who have severe mental disorders. The application of the restrictive approach is thus associated with ensuring the safety of the staff and of the patients in times of aggression to control problematic behaviours (Dixon & Long, 2022). Due to limited evidence of its efficacy and questions on its ethical application and violation of the principles of human rights, several alternative approaches for restraint based activities have also been developed and are promoted for the patients (Masters, 2018).

Policies and guidelines developed by the Government of Australia

These alternative therapies include focussing on individualised care and advocacy of regulation activities of the patients. It also helps in the minimisation of changes in daily life activities and promotes a more scheduled way of living. An alternative approach that is promoted in psychological care facilities to minimise the use of restrictive practices is the use of intervention called "restraint fading". Restraint fading is an approach that is applied by behaviour analysts and is used primarily for patients that have self-injurious behaviours. These behavioural modification techniques have been found to be effective in mitigating patients with severe mental health disorders and reducing the risk of violence or harm (Baker et al., 2021). To apply restraint fading, it is important that staff training and organisational planning are developed to reduce the restriction based approach. The least restrictive alternatives include verbal de-escalation techniques and ensuring low stimulation in the environment. The use of sensory modulation technique is beneficial for ensuring reducing the sensory overload and anxiety in the patients and reduces the risk of violence or harm in the patients (Furniss & Biswas, 2020).  

Therapeutic care and systematic interventions have been found to be helpful in increasing the compliance of mental health patients towards the care interventions and reduce the incidences of violence are the use of active nursing interventions (Dixon & Long, 2022). A nurse is a primary care service provider and can have a major impact on the recovery of patients. The mere presence of nursing staff with a good patient and nurse relationship has been associated with long-term improvements in recovery and reduced cases of aggression and violence. This is effective as the patient gets engaged in the care and feels respected and dignified. The active participation of patients in the process of care through the development of the therapeutic relationship is also beneficial for decreasing the incidents of aggression and promoting patient cooperation in the psychological care facilities (Furniss & Biswas, 2020). In conjunction with the nurses, patient safety attendants (PCA) have also been found to be effective. However, for the effective application of these interventions, staff training is critical and should be applied in all inpatient facilities (Baker et al., 2021). These help in establishing a sense of authority and helps in controlling the violent or harmful tendencies in the patients. Further, the number of individuals attending the patient should be reduced. This will help in strong communication and therapeutic relationship with the patient and promote better recovery and outcomes without the use of restrictive practices (Bloch & Smith, 2018).

Conclusion

Mental health patients have been associated with taboo in history that has led to their seclusion and isolation. Mental health patients have diverse needs and thus require comprehensive care. However, in certain severe mental disorders, the patients may become violent and may implicate harm to themselves or to others in the facility. This may result in the imposition of restriction based interventions on the patients that can either be physical, chemical, or environmental. This paper discusses the impact of restriction based interventions on the patients and outlines that the application of restrictive interventions can be traumatising for the patients. Further, it also harms the relationship between the nurse and the patient and with the family of the affected individual. The paper also outlines the policies and guidelines developed by the government of Australia that discourage the use of restrictive practices in the inpatient facilities of psychiatric care and asserts that these practices should be eliminated if possible and should be minimised in the care facilities. Therefore, alternative interventions such as behavioural changes, changing of the environment, and training and support of the nurses should be used and encouraged.

Best therapeutic outcomes and focus on recovery in mental health services

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