Use of restraint in a psychiatric hospital

Abstract

Managing patients who are aggressive and violent is a challenging task for staff of psychiatric hospitals. Physical or chemical restraint is resorted to when verbal counseling does not help in de-escalation. It is often believed that restraint is very often overused in psychiatric hospitals. In the Indian clinical settings there is no data available to know the frequency, duration and method of restraint practices. Method: The study was done prospectively over a two month period in a tertiary psychiatric hospital. There were 394 admissions during the study period and pattern of restraint was studied. Aims and Objectives: To study the restraint practices in a psychiatric hospital, to study the frequency of restraint, to study the diagnostic categories of patients requiring the restraint, to study the duration of restraint, and to study the method of restraint. Conclusions: Restraint is required in some of the patients and it cannot be avoided totally. Chemical restraint was the most common type of restraint used to control agitation and violence. Only 1/3 rd of patients admitted during the study period of two months required restraint. Only 13% of the restraint events were mechanical restraint. The duration of mechanical restraint was less than 2hrs in 75% of the time and it did not exceed 4.5hrs at any time.