The practice of psychiatry has changed substantially over course of its existence, however, the utilization of restraints in adult psychiatric inpatient units has continued to remain a constant (Jacob et al., 2016). Various studies have shown that there are several factors that lead to the persistent use of these mechanisms (Jacob et al., 2016). Interestingly, these factors have been shown to include, but are not limited to, elements involving the patient (Jacob et al., 2016).
For a patient, the kind and severity of his or her mental illness are the most important factors for being subjected to any form of physical or chemical restraint. Male patients are typically more aggressive, whereas females are more inclined to engage in self-harm. Acts of self-harm and/or attempted suicide during current admissions significantly correlate with young persons whom have a history of harming themselves. Such occurrences typically transpire during evening hours, with antecedents of a distressing psychological state, threatening behaviors, and conflict with staff noted to occur beforehand (Jacob et al., 2016). Additionally, patients who were admitted involuntarily were restrained and secluded at significantly higher levels than those who willingly admitted themselves, and minority persons and immigrants were more likely to be subjected to coercion (as cited in Jacob et al., 2016).
Relatedly, in a study examining the trend of restraint episodes occurring over the course of a six-year period, Jacob et al. (2016) found that males were typically restrained for significantly longer periods than females. Likewise, episodes that were accompanied by medication administration, versus those that were not, were noted to last longer (Jacob et al., 2016). Similar trends were also reported to occur with respect to restraint episodes that involved verbal redirection being given compared to incidents with no redirection and episodes that occurred during evening shifts versus those that took place earlier in the day (Jacob et al., 2016). Overall, each of these episodes was noted to be incited by an outward display of aggression (Jacob et al., 2016).
Jacob, T., Sahu, G., Frankel, V., Homel, P., Berman, B., & McAfee, S. (2016). Patterns of restraint utilization in a community hospital’s psychiatric inpatient units. Psychiatric Quarterly, 87, 31-48. doi: 10.1007/s11126-015-9353-7
Shirreka Mackay, LPC
WKPIC Pre-Doctoral Practicum Student
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