Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients from South India

Abstract

Background: Coercion and restraint practices in psychiatric care are common phenomena and often controversial and debatable ethical issue. Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients have received relatively less research attention till date. Aims: Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients. Methodology: This is a hospital-based, a descriptive, cross-sectional study. A total of 200 (n = 200) consecutive patient and their caregivers were chosen between June 2013 and September 2014 through computer-generated random numbers sampling technique. We used a semi-structured interview questionnaire to capture caregivers’ attitude and perspective on coercion and restraint practices. Sociodemographic and coercion variable were analyzed using descriptive statistics. McNemar test was used to assess discrete variables. Results: The mean age was 43.8 (±14.9) years. About 67.5% of the caregivers were family members, 60.5% of them were male and 69.5% were from low-socioeconomic status. Caregivers used multiple methods were used to bring patients into the hospital. Threat (52.5%) was the most common method of coercion followed by persuasion (48.5%). Caregivers felt necessary and acceptable to use chemical restraint (82.5%), followed by physical restraint (71%) and electroconvulsive therapy (ECT) (56.5%) during acute and emergency psychiatric care to control imminent risk behavior of patients. Conclusion: Threat, persuasion and physical restraint were the common methods to bring patients to bring acutely disturbed patients to mental health care. Most patients caregivers felt the use of chemical restraint, physical restraint and ECT as necessary for acute and emergency care in patients with mental illness.

Patient safety in inpatient mental health settings: a systematic review

“…Studies explored staff,148–157 patient147 158–165 and mixed groups’166–173 views and experiences of seclusion and restraint. Nine studies focused on the processes surrounding seclusion and restraint 136 137 174–180.…”

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review

“…There was a dearth of literature exploring carers’ experiences with seclusion and restraint in mental healthcare settings. The emphasis in this area was more about exploring levels of carers' knowledge, attitude, and perspectives on coercive practices (Gowda et al 2019; Shrestha 2018). This dearth of literature presented difficulties in making conclusions around carers’ experiences.…”

Alternatives to use of restraint: A path toward humanistic care

“…The practice of restraint and attempts to reduce its use by alternative methods have been attempted in various clinical settings such as (a) acute psychiatry ward,[ 4 7 ] (b) long stay homes for mentally retarded and patients suffering from severe and chronic mental illness, (c) child psychiatry wards,[ 8 ] and (d) elderly care nursing homes. [ 7 ] Restraint in acute psychiatry ward is predominantly used as a means to control aggression and in turn decrease the harm to self and others,[ 9 10 11 ] whereas in child psychiatry wards and long-stay homes, it is used to control problem behaviors. [ 8 ] It is used in elderly nursing homes as a means to decrease the mobility of the patient so as to ease the process of care and to decrease the injuries to self.…”