Restraint – 10 ways it harms psychiatric patients

19 Jun
Greer Garson, Lauarence Olivier, Maureen O'Sullivan & Bruce Lester in Pride and Prejudice

Greer Garson, Laurence Olivier, Maureen O’Sullivan & Bruce Lester in Pride and Prejudice

 

Restraint. It’s such a polite word. What does it mean to you? Genteel Victorian ladies in romance novels? Bondage in Fifty Shades of Grey? Artistic photographs from the Held exhibition? Or perhaps the word conjures up the grotesque inhumanity of the face-down restraint and forced medication that take place on psychiatric wards up and down the country every day of the week and which are the subject of mental heath charity Mind’s new campaign. (See below for links to Mind’s campaign, press coverage, commentary and resources.)

The word restraint is reminiscent of Victorian novels of manners such as Jane Austen’s Pride and Prejudice. Of elegant ladies and gentlemen, like the renowned actors pictured above, exercising self restraint to stay within the confines of the social norms of the day. Rather than going “at it like knives on battered settees” (to quote a humorous song), characters manoevre to form genteel and restrained attachments.

Restraint also has connotations of the erotic kind. That’s especially so since the Fifty Shades mommy porn phenomenon brought bondage to the mainstream. By now there’s a Fifty Shades of Grey official pleasure collection, which includes a bed restraint kit, “approved by author” E L James. There’s even a parody novel incorporating Pride and Prejudice, called Fifty Shades of Mr Darcy.

A photograph from the held exhibition by Jane Fradgley

A photograph from the held exhibition by Jane Fradgley

Some think of restraint in mental health settings as an interesting topic for art, fashion, photography and academic discussion. Photographer and fashion designer Jane Fradgley’s exhibition Held (see here and here) has a related symposium on restraint. Her photographs are inspired by the historical collection of “strong clothing” at the Bethlem Royal Hospital Archive & Museum and explore her impressions of restraining garments as facilitating dignity, comfort and protection. That’s straight jackets..

When I hear the word restraint, however, the first thing that springs to mind isn’t Victorian ladies, saucy pleasures or artistic photos. It’s the brutal reality I’ve experienced of being pinned face down by teams of six as a vulnerable psychiatric inpatient. It was done to me repeatedly, to administer medication. There was never a justification. It was done to me without warning. It was done to me without explanation. It was done to me without any shred of compassion. It was done to me routinely, on a schedule I was not told about. It was done to me as a first resort.

It’s too traumatic for me to write about again. However, if you want to know more, read this blog, Treated Like an Animal, where I describe one incidence of face down restraint step by step.

Late yesterday, when I checked twitter,  my feed was filled with references to restraint. It was not good for me: here‘s my reaction. Hours later, after the flashbacks and tears had subsided, I was still sick to my stomach, heart pumping, unable to sleep.

Why had there been so many tweets on my feed about restraint? Because mental health charity Mind was publicising the launch of its campaign around the use of physical restraint in mental health care using the hashtag #crisiscare. As Mind says:

“When people’s lives come crashing down in a crisis, they need help not harm. We’re calling for national standards on the use of restraint, accredited training and an end to face down restraint. Excellent crisis care exists. It can save lives. And that’s why we need it available for everyone.”

It’s an important campaign, and one which must succeed so that the harms like those that were inflicted on me when I was at my most fragile aren’t allowed to be imposed on others in the same way. Here’s my personal experience of the harm done by physical restraint in a mental health setting:

  1. It destroyed any chance of developing a therapeutic relationship with ward staff. Staff became my jailers and tormenters, wielding arbitrary power, casually chatting over me to each other as they did their business. All I was interested in while on ward was discharge, not healing: get out, get away from staff and make sure they never came after me again. Fear of psychiatric staff affects me to this day.
  2. Mentally I was pushed to a place I would never have gone to had I received care rather than violence. At my most vulnerable, I was brutalised. Like smashing down a sledge hammer again and again on a tender broken wrist instead of enveloping it in a protective plaster cast, these restraints made me much, much worse than I ever needed to be.
  3. Each time it was done to me, I was reduced to the state of a cornered animal, running on stress hormones, on fear and instinct. My dignity and humanity were removed. (One time I was carried face down and shoeless through wards and corridors and past men playing snooker, with no explanation. I was so terrified I wet myself and was left in my own urine, watched through a porthole at 15 minute intervals. After some time, I was carried back the same way.)
  4. These physical restraints caused distress to other patients, who would hear me crying out in fear as I was manhandled, or see me being taken through the ward face down.
  5. I was physically injured by being yanked, pinned down, knelt on and injected. My buttocks were bruised meaning I was unable to sit. I was covered in lumps and great purple and green bruises and finger marks. Although the severe bruising and lumps have healed, two years later I still carry two physical injuries (one serious and for which I still receive treatment). (None of these injuries will be recorded in hospital records.)
  6. Two years later, simply hearing or seeing the word “restraint” can bring on overwhelming flashbacks and deep physical responses. Two years later, I can’t even can’t watch light-hearted TV programmes with traffic police in them because, sooner or later, there will be a big scrum when officers pin down a suspect. Just seeing that can trigger the flashbacks too. I can’t even lie on my tummy without it reminding me of being brutally pinned down.
  7. Two years post-discharge, the symptoms I still struggle with – and spend a lot of time managing – relate to my treatment on ward (flashbacks and physical symptoms), not what brought me onto the ward in the first place.
  8. I have been diagnosed with Post-Traumatic Stress Disorder as a direct result of my ward experiences (I am on a waiting list for treatment).
  9. Friends and family are horrified at the barbarism of what was done to me, putting them off seeking psychiatric help themselves.
  10. Having experienced what can go on behind closed doors when no-one is looking, I will never go back into a psychiatric ward, no matter what.

Since discharge, I’ve learned that restraint is a physically risky process in which people can die, so my fears were justified. Recently I bumped into a woman called Cheryl Prax. I spent 90 minutes listening to her describe her experience of having her arm broken in two places when she was restrained by psychiatric staff (see her speak about it here).

Why am I giving all this personal detail? Because staff may believe that using physical restraint helps them to manage the ward environment in the short term. But perhaps, as caring professionals, they will reflect on the long-term implications, both physical and mental, for those on the receiving end. And perhaps they’ll reflect that some mental health trusts have already banned the use of face-down restraint without losing control of the wards.

And now it’s not just me who’s saying they have had bad experiences being pinned down by psychiatric staff. Now there’s a national campaign from Mind to get rid of this barbaric practice once and for all. See the links below to see what you can do to help. Please help. Because this monstrous practice must stop.

There are numerous links below.

.

.

web links 5

My thoughts on restraint:

.

.

Material related to Mind’s crisis care campaign on the use of restraint:

.

Commentary & additional material:

.

Press coverage of the story:

Nationals:

Locals:

.

.

The saucy side of restraint, plus art:

.

.

Advertisements

13 Responses to “Restraint – 10 ways it harms psychiatric patients”

  1. goldenpsych 19 June 2013 at 10:01 am #

    While you may have had a negative experience, I just wonder if you can see the situations where restraint is necessary in protecting the patient, other patients and staff? I have seen it from both sides. Having worked in psychiatric care I have been in numerous situations where I have had to restrain someone else to prevent them causing harm to themselves or others. It is usually a last resort and only used in an emergency situation.

    I being a patient on a psychiatric ward have also been restrained numerous times. Most of the time it was for my own safety or to stop me from leaving the ward. I understand why they had to restrain me in those situations. There was one situation that went too far where I actually got bruising and sore arms from the person restraining me as he was going too far. I did complain about him and he was suspended and further action was taken against him.

    Unfortunately, restraint is one of those things that is needed in psychiatric care. It should be only used as a last resort and it is done in a controlled way. All staff undertake a restraint training course so that accidents don’t happen and so that everyone is on the same page. It comes about after the case such as Rocky Bennett, who died after being in restraint. But, yes, sometimes, the odd bad apple can jump in too fast and it not be done correctly.

  2. H 19 June 2013 at 10:49 am #

    Hi,
    I’ve been reading, with a heavy heart, the effects that physical restraint have had on you. Im so sorry that you have been treated in such a way, hardly effective treatment at a time of crisis.
    I am a support worker and work in a secure hospital, and as such have had to be trained in the use of physical restraint. For the record, I hate the whole concept of it, not only does it seem a huge power trip, but adrenaline from an aggressive situation isn’t helpful to me at all, it provokes a range of symptoms in me which I struggle to cope with. There have been occasions though, where the physical restraint has been the final and only option. I truly believe in therapeutic relationships, but when all else fails and as a staff, you are talking to a person who is kicking and punching you, using weapons against you, and at times threatening your life, it can reach the point where restraint is necessary.
    There are, as you have experienced, some bad practices. For me, restraint was always the last possible option, and that didnt always make me popular.
    I am replying to you, to highlight another point. I was injured in an assault at work, some months ago, which has left me with limitations in my job. Restraint being the foremost. My employer, won’t have me back on the unit because of this, even though I have a track record of being a person centred, fair worker. My skills and ethic mean nothing if I can’t get physical!
    Unfortunately it seems, the more staff who become injured and end up with limitations to their work, the more the shift in these places becomes focused on the restraint, and staff ability to do it.
    I am truly sorry for your experiences, and only hope that you never come across these bad practices again. Please though, bear in mind that not all of us that are trained to restrain, actually enjoy doing it, and sometimes get hurt because of their reluctance to take things to that point.
    My best wishes, and hugest respect to you, for speaking out.
    H

    • Fuck You 12 May 2014 at 8:55 am #

      Fuck you and the stupid system you worked for. I was held against my will by 5 people and they were aggressive as they could possibly be after I was already restrained by grinding my face, leaving multiple bleeding cuts on my face and in my mouth. If you had the common sense to be against any type of restraint you would have never worked there in the first place.

  3. Clutter 23 June 2013 at 11:30 am #

    Had you been an animal and tranquilised by rifle from some distance I think it might have been kinder than the barbaric way you were treated. I’m so shocked that anybody can believe your treatment was appropriate or acceptable. I doubt Bedlam was as brutal in its day.

    Now, in addition to the illness necessitating your hospitilisation, you have a hospital acquired illness, PTSD and are queuing for treatment to address the brutal assaults upon you. I’m outraged on your behalf. Nobody deserves such cruelty. You weren’t nursed and tended as you should have been. You were brutalised by gaolers.

  4. Judith Lewis 31 July 2013 at 11:11 pm #

    It’s part of a wider problem too. It’s difficult to safely manage someone acutely distressed, agitated and aggressive in a ward environment. But a good ward will be run in such a way that there is less risk of anyone ending up in such a frightened and frightening state. I’ve worked in in-patient settings where restraint was something that was rarely considered or necessary. And in wards where it was all too common. Partly because there were not enough good staff or quiet places to stop people escalating into states where restraint is used. And then it starts to be used as a default. So I do agree there needs to be a whole rethink on the subject. But it won’t work unless there is a rethink on the culture of in-patient units generally.

  5. Morag 4 March 2014 at 1:16 am #

    Thank you for raising awareness of this. I do still have flashbacks, recalling my fear and the sounds made by a male nurse as he pinned me a slight 14 year old girl back. I was restrained not because I was at risk to myself or others and the experience of such and knowing that all these people had the capacity to be so force able destroyed any chance of a therapeutic relationship.

    That’s said I do understand that on some occasions restraint is the only option, a fellow patient was prone to violently attack and had to be pulled off of me. However, you have to question whether all that could have been done before hand to prevent such behaviour and the subsequent restraint was done so. On many occasions this was not the case, and for that patient the staff most of the time didn’t even try it was just the usual routine of restraint and sedation. This was a fellow child.

    Restraint is far too over used, and can cause great physical and mental harm. Destroying the recovery process.

Trackbacks/Pingbacks

  1. Physical Restraints - 19 June 2013

    […] an article titled Restraint – 10 ways it harms psychiatric patients on Sectioned’s blog […]

  2. Hospital inspections and dashed hopes | Sectioned - 14 March 2014

    […] Restraint – 10 ways it harms psychiatric patients (June 2013) […]

  3. Forced medication: resistance is futile | Sectioned - 19 March 2014

    […] Restraint – 10 ways it harms psychiatric patients (June 2013) […]

  4. Secrets from the modern day asylum | Sectioned - 27 August 2014

    […] Restraint – 10 ways it harms psychiatric patients (June 2013) […]

  5. Do you remember your first time? | Sectioned - 16 November 2014

    […] Restraint: 10 ways it harms psychiatric patients – My second blog post on forced treaatment (June 2013) […]

  6. Use of force on psychiatric patients – 3 recommendations for starting to reduce the harms it causes | Sectioned - 22 October 2015

    […] Restraint: 10 ways it harms psychiatric patients […]

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: