Psychiatric Crisis Intervention & Use of Restraints

The management of acute crises in a psychiatric setting generally depends on a continuum of therapeutic measures. This continuum includes an entire spectrum of intervention strategies. One component of the spectrum is mechanical restraint. Throughout history, some form of physical restraint has been used to treat the mentally ill. While mechanical restraints are still widely employed in psychiatric hospitals today, the practice is becoming more and more controversial. As with any therapeutic modality, restraints have their inherent risks and benefits. All of these various factors must be carefully considered if health care is to be delivered in an acceptable manner.

Prior to the 18th Century, methods used to restrain the mentally ill tended toward cruelty (Roper et al., 1985, p. 18). Although in modern times, mechanical restraints are generally applied more humanely, many consider their use outdated, offensive, unnecessary, and even harmful. In fact, research has shown that manyif not mostnurses actually dislike the technique. It tends to conflict with their basic values such as the "patient having a right to selfdetermination" and the "nurse's responsibility to act in the patient's best interests" (Quinn, 1993, p. 148162). In the psychiatric setting, the primary reason for the application of mechanical restraints is management of violent or outofcontrol behavior. The mentally ill demonstrate their

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ilitation patients were found to have undergone restraint. In some longterm care facilities, those numbers can climb to as high as 85 percent. While more commonly these patients tend to be older, studies have shown thatin psychiatric hospitalsthe majority of restrained patients can be under 45 (Robbins et al., 1987, p. 293294). Regardless of age though, patients at a higher risk of eventually requiring these methods include those who demonstrate impaired cognition, poor judgment, or behavior disorders in conjunction with some form of impaired physical function (Mion et al., 1989, p. 954). Differences in gender and race do not appear to be significant. Another factor regarding the use of restraints is its variability. Research has discovered major differences in the prevalence of their administration. Hospitals which operate under identical regulations and possess identical admission/discharge policies have been found to have widely differing patterns of restraint application. For example, violence toward male staff members may lead to twice as many episodes of restraint and seclusion as violence toward female staff (Miller et al., 1989, p. 520). Part of this variability can be attributed to the inherently subjectiv
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Approximate Word count = 2420
Approximate Pages = 10 (250 words per page)

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