Mental Health Nursing, Mechanical Restraint Measures and Patients’ Legal Rights

Abstract

Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular challenge to psychiatric patients’ legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented. This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients’ rights call for taking notice of patient evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient’s mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and promote patients’ rights, education of psychiatry professionals must address the need for, as far as possible, paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation requirements.

Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review

“…Coercive treatment is an exception with respect to all other medical treatments, which, though they may be necessary, cannot disregard the requirement for informed consent and can always be refused. Danish law 2 highlights the exceptionalism of nonconsensual treatment, allowing it only after attempts to obtain consent, coherent with the view of “minimal intrusive remedy” (17). The Lanterman–Petris–Short Act, introduced in the USA in 1967 and implemented in 1969, represented the prototype for mental health laws in many other western countries (18).…”

The rationale for shared decision making in mental health care: a systematic review of academic discourse

“…Authors also highlighted how these principles are now becoming legal standards for medical care (Birkeland & Gildberg, 2016;Drake et al, 2010;Drake, Cimpean, & Torrey, 2009;Joosten et al, 2008;Joosten, de Jong, de Weert-van Oene, Sensky, & van der Staak, 2009). These arguments were not explored in-depth in these papers, however it was noted that there may be strong ethical arguments for a temporary shift to a paternalistic mode of decision making in cases where a person's insight is impaired (Seale et al, 2006).…”

Conceptual framework for a comprehensive competence in managing challenging behaviour: The views of trained instructors

“…Coercive measures may include forced medication, seclusion and physical restraint (Cowman et al, 2017; Kaunomäki et al., 2017). Mechanical restraint is forbidden in many countries but commonly used in some countries, for example, Denmark (Birkeland & Gildberg, 2016) and Finland (Mental Health Act 1116/1990). Coercion contravenes autonomy and informed choice by forcing people to undertake a course of action over which they have little or no control (Newton‐Howes, 2010).…”