What is restraint?
Restraint is a physical intervention to de-escalate a potentially dangerous situation and protect everyone who could possibly be involved. This includes protecting the person from endangering themselves or other people. A restraint is non-violent and should only be applied as a last resort. If it is applied violently or needlessly it is not restraint- it is assault.
I will talk about restraint in the context I am most aware of- acute mental illness.
When is Restraint Necessary?
Restraint may be necessary if a person is an active risk to themselves or others. Depending on the situation different restraint techniques can be adopted. For example there are methods to disarm somebody with a weapon, prevent someone from kicking out and injuring surrounding persons or doing something to harm themselves. Techniques like talking, distraction and diversion should be used first.
Having someone restrain you is frightening. I’ve been there. The distress that could be caused by the restraint should be carefully weighed against the distress and harm that would be caused by not intervening. The intervention should be protection never punishment.
Sometimes medication needs to be administered to a person in a restraint in order to end the need for force as quickly and easily as possible. Sometimes this is done through injection as it is unsafe for tablets to be forced into the mouth of a patient held in a restraint.
Charities like Mind have clear cut guidelines on restraint and are calling for an end to be brought to face down methods. This is the most dangerous kind of restraint as breathing can easily be inhibited.
NICE Guidelines State:
“Sometimes people with mental health problems may need to be controlled or restrained by staff when in hospital, or have treatment without their agreement (such as medication to calm them down quickly). This should be a last resort. If this happens to you, it should be done by trained staff, and preferably by staff you know and trust. They should act with your best interests at heart and will make sure you are safe while using minimum force.”
But aside from this there is very limited legislation on what is and isn’t allowed when it comes to physical restraint.
What is it like to be in a restraint?
I have been in a lot of restraints. They would happen when I lost control of myself and was endangering my life with self harm or suicide attempts in hospital. I’m lucky enough not to remember a lot of them, one good thing about my condition is the dissociative ‘brain blanks’. There is a point where you are suddenly not in control of anything anymore and there are people on top of you. Moving you and communicating between themselves in a language you don’t understand. Sometimes my response was anger to the sudden enslaught and other times it was relief. A restraint does rescue you from yourself when you aren’t safe to be in the driving seat anymore.
Sometimes on the ward a large beanbag patients named ‘fat boy’ was involved to stop kicking and flailing limbs. Sometimes restraint was traumatic- a group of staff you barely know coming into your room and pinning you to the floor feels like an attack however with the right staff I wouldn’t fight as much because it felt safe. I always knew during this time that my body was out of control. I wanted to hurt myself and I wanted them to let me get on with it because that was the only way I could see the situation getting better.
I’ve been in bad restraints. Ones where I’ve come away with black bruises on the tops of my feet or muscle strains from being pulled around. Restraint was common practice on my first unit, happening several times a day with some staff using it as a first response to any sign of trouble. Most of my restraints were justified by my dangerous behaviour towards myself, but there are many situations that could have ended much better with a calm chat and a hug. It’s these ones that stay with me.
Restraint being used too frequently, like in my case, is a bad thing. When I moved to another unit with a more appropriate attitude towards the practise I was confused. For six months I had become used to my inner battles being resolved by third party restraint. To be doing the same things as in my original unit but with no restraint from staff felt dangerous and scary. I went from being restrained sometimes multiple times a day to not being in restraint at all. It makes me realise how grateful I am to the good staff at my first unit for making clear that the restraints were a rather unpleasant strand of my treatment that I’d get through and that they wouldn’t let anything happen to me. I am increasingly thankful too for *Cheery Lodge, because if I had been discharged straight from *Heron into the community I would have without a doubt died from the sudden lack of protection from my mind’s demands for danger.
Over time I’ve become a master in restraint myself. I can’t pin myself to the floor but I’ve learnt how to talk myself down; how to de-escalate situations and how to compromise with my mind. My body was being overrun by my mind, it was doing what the literal ‘head office’ told it to do by hitting the destruct button. That girl who was thrashing around on the floor is still there some days, but her body restrains her now. My body, brain and I keep the thrashing internal. Some days it’s harder than others. I suppose we all have to learn how to restrain ourselves one way or another.
A year ago today I moved unit via secure ambulance to *Cheery Lodge. I cannot thank the people there enough for giving me a base and support. Recently a member of staff from the unit I was moved from a year ago was suspended for misuse of restraint. More about my (surprisingly hilarious) transfer can be read here.