Restraints used on 1 in 4 psychiatric patients

Nearly one in four people in mental health wards in Ontario are restrained using straps, sedative drugs or other methods, according to a new report.

The analysis by the Canadian Institute for Health Information looked at "control interventions," such as:

• Fast-acting medication to control agitation and to prevent harm to self or others.
• Mechanical restraints, such as being strapped to a bed.
• Physical restraint, such as holding down a patient.
• Seclusion or confinement in a room.

The purpose of the report was to help hospitals to understand how to reduce rates of restraints, given provincial and international legislation and guidelines on minimizing their use.

Such protocols have been introduced in about the last 10 years, said Ian Joiner, manager of rehabilitation and mental health with CIHI in Ottawa. 

The move towards minimizing use of restraints and looking for alternatives came about after researchers realized that use of restraints can be traumatic for patients, Joiner said.

"There appears to be some room for further reduction or improvement in these rates," Joiner said.

Psychiatric patients were much more likely to have experienced a control intervention at a general hospital than at a psychiatric hospital, the report's authors found.

"Most people who are admitted to hospital for mental illness  actually come through the emergency department," Joiner said.

It's hoped the report will help hospitals to share strategies for successfully reducing use of restraints, such as more training for staff to communicate with people who are in a psychotic, or confused state, or experiencing a severe mental health crisis, he added.

For example, patients showing disruptive behaviour can agitate others, so talking to patients in an area separate from others could help, Joiner suggested.

The report raises awareness and should encourage care providers working with mental health patients to examine their own facility's practices and come up with approaches other than constraining patients, agreed Debra Churchill, director of professional practice for the 329-bed Ontario Shores Centre for Mental Health Sciences in Whitby, Ont., northeast of Toronto.

Factors associated with use of control interventions included:

• Being male.
• Showing aggressive, disruptive or self-injurious behaviours.
• Experiencing cognitive impairments often associated with dementia.
• Having a diagnosis of schizophrenia or psychosis.

The report was based on data for more than 30,000 individuals discharged after at least three days in Ontario between 2006 and 2010. The researchers believe rates of control interventions likely do not vary much across the country.   Since reporting of control interventions is not required, the findings likely represent a conservative estimate, the authors said.