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View Full Version : Seclusion and restraints in mental hospitals


Cosmos Jack
05-06-2003, 03:23 AM
I know allot of you may not know what I'm talking about, but I will explain. Seclusion and restraints are used as a means of coming extremely agitated and violent patients down. Seclusion is a bare room with a bed that has an option of being locked. Restraints are used in the same room in the case the Patient is not calming down and becomes even more agitated and violent. They may try to harm themselves or lash out at other Pts and staff.

Now the point of this thread is to discus opinions on the use of these methods. At the moment psychiatric medicine is moving towards no use of seclusion and restraint. I also know allot of you have never dealt with a severely mentally ill person. Allot of you may think the above idea of putting a person in seclusion and restraints is cruel. This is why I started this ;)

I hope I have said enough to get the subject rolling. I will respond to the ideas that are posted.

Wacky_Baccy
05-06-2003, 07:04 AM
Intriguing thread subject :)

This actually reminds me of the "medicate to execute" thing going on in the US now... *leaves it at that*
Posted by Cosmos Jack
Now the point of this thread is to discus opinions on the use of these methods. At the moment psychiatric medicine is moving towards no use of seclusion and restraint. I also know allot of you have never dealt with a severely mentally ill person. Allot of you may think the above idea of putting a person in seclusion and restraints is cruel. This is why I started this ;)
I do think it's cruel to put a mentally ill person in 'seclusion' or restraints to calm them down, but more than that, I think it's counter-productive. You will never solve whatever problem got them upset in the first place using those tactics, because they are most likely incapable of reasoning out why they got upset on their own - they need help, guidance, and reassurance - they can't do it on their own, but that doesn't necessarily mean they can't do it.

(Can you tell I don't like the idea of giving up on people? :))

Sure, sometimes you won't be able to help them understand why they got agitated or distressed in the first place (and how to cope with that in future), but surely it's better than just shutting them in a room to leave them to their confusion and frustration, no?

I've had a little bit of experience with mentally ill people (one was scizophrenic), and it always seems to me that if you spend some time with them and try to help them sort things out, it turns out much better than it would if you locked them away i na room and forgot about them and their problem (I realise all too well how enormous a burden for one person something like this would be over time, but I'm not saying it should be one person doing it).

Avoiding problems is always the worst thing to do - I know that first hand and I wish I'd known it years ago - you have to solve problems, and in a way that suits the person with that problem - this applies to such a range of things that I'd be typing for a week if I covered them all now, so I won't :p

In short, I'm convinced that it's always best to confront a problem that ignore it, even if you're no better off after confronting it - at least there's a slightly better understanding of what the problem is and how to deal with it.


More later if I feel up to it =)

Dagobahn Eagle
05-06-2003, 12:07 PM
Restraints are also deregatory.

Cosmos Jack
05-06-2003, 12:38 PM
Not to offend you or anything but you sound like most Doctors. They come in maybe 1 or maybe 3 times a week and talk to their pts, however; they will be the 1st to jump back when a pt literally jumps at tech and starts trying to claw there eyes out and bite there neck. When they go from saying high sweaty to that in less than a 10 seconds it's really hard to talk them down and intervene. If you think you can do it I would like for you to come and apply at my hospital. I'm being serious.
Originally posted by Wacky_Baccy
I do think it's cruel to put a mentally ill person in 'seclusion' or restraints to calm them down, but more than that, I think it's counter-productive. You will never solve whatever problem got them upset in the first place using those tactics, because they are most likely incapable of reasoning out why they got upset on their own - they need help, guidance, and reassurance - they can't do it on their own, but that doesn't necessarily mean they can't do it.It's also cruel to let them walk down the halls hitting staff and other pts. Not because there upset, but because they want to hit people today. We had one pt a few weeks ago I wasn't on that unit, but he calmly walked out of his room and down the hall. He walked in to the first open door where a pt was taking a shower. He presided to beet the guy to pulp. This happened not, because he was mad at the guy or even new him, but because his door was left open and he wanted to beat someone up.
Originally posted by Wacky_Baccy
In short, I'm convinced that it's always best to confront a problem that ignore it, even if you're no better off after confronting it - at least there's a slightly better understanding of what the problem is and how to deal with it. It's not like we do seclusion and restraints at the drop of a hat. This is done after all intervention and talking to the pt has been ineffective and the pt is still acting out. I don't know the exact numbers, but I would say about 90% of the pts never are secluded and restrained if only once. I have had several successful interventions with pts where it didn't come down to forcing them in seclusion. Some pts will get really upset about something and actually come up to the staff and ask to go in to the seclusion room.

It's not a punishment, but someplace where they can go away from the negative stimulus that made them upset in the first place. The pt goes in and sets down. The door is only locked if the pts is really violent and unredirectable. After they calm down they process with staff about what happened and talk about ways to avoid it in the future. Itís not like we lock them in and throw away the key. Maybe go eat a Big Mac on are brake come back and say get the hell out. Itís regulated only a Dr. can sign the order to put them in seclusion or restraint. Even than itís only for an hour or until the pt comes down. If not the Dr. signs for another hour. Even with this some pts will calm down just to get out and attack someone so you have to be careful on who youíre dealing with.

Some pts can't be reasoned with ether because they don't want to be or are incapable of being at that time. So what do you do in that case? Do you let them beat you up or other staff and pts what do you do? I have only been in this field for 4 months now and I already know people that have been injured by pts and can't work anymore. Seclusion and restraints aren't a punishment, but can be a deterrent. The day some of them pts wake up and figure out that they can no longer be restrained I will quit my job. I have no desire to get my eyes poked up or get bitten and have a limb broke. Some of the pts have AIDs and other diseases and will try to give that to you as well. The day when we loose that little bit of control a lot of people have said they will quit. Personally I will go try out for the police department at least I can shoot back.

This was really long. I know a made allot of mistakes in there. :o

Wacky_Baccy
05-06-2003, 04:43 PM
Originally posted by Dagobahn Eagle
Restraints are also deregatory. I think that must be your shortest comment ever in a Senate thread, Eagle :D

Can I take it as meaning that I'd already said everything else you were going to, then? ;p

Posted by Cosmos Jack
Not to offend you or anything but you sound like most Doctors. They come in maybe 1 or maybe 3 times a week and talk to their pts, however; they will be the 1st to jump back when a pt literally jumps at tech and starts trying to claw there eyes out and bite there neck.No offence taken - I'm sure I'd react that way for a while :)

When they go from saying high sweaty to that in less than a 10 seconds it's really hard to talk them down and intervene. If you think you can do it I would like for you to come and apply at my hospital. I'm being serious.In all honesty, I'd genuinely love to - but I can't relocate to the US at the moment, sadly... Maybe I'll do something similar over here on my wet little green island... Who knows. :)

It's also cruel to let them walk down the halls hitting staff and other pts. Not because there upset, but because they want to hit people today. We had one pt a few weeks ago I wasn't on that unit, but he calmly walked out of his room and down the hall. He walked in to the first open door where a pt was taking a shower. He presided to beet the guy to pulp. This happened not, because he was mad at the guy or even new him, but because his door was left open and he wanted to beat someone up.Okay, I'll admit that I'd not given the scope of behaviour nearly enough consideration - I agree that it's best [and probably best for everyone] that people who display that kind of behaviour to be separated [forcibly if necessary] from others until they are in a stable state - I certainly won't deny staff at mental hospitals their right to safety - ever.

It's not like we do seclusion and restraints at the drop of a hat. This is done after all intervention and talking to the pt has been ineffective and the pt is still acting out. I don't know the exact numbers, but I would say about 90% of the pts never are secluded and restrained if only once.I'm glad to hear it =)

I have had several successful interventions with pts where it didn't come down to forcing them in seclusion.That encourages me more than you can imagine =)

Some pts will get really upset about something and actually come up to the staff and ask to go in to the seclusion room.When I give it due thought, that makes an awful lot of sense.

This is why I love the Senate - it makes me see things from many different angles :D

It's not a punishment, but someplace where they can go away from the negative stimulus that made them upset in the first place. The pt goes in and sets down. The door is only locked if the pts is really violent and unredirectable. After they calm down they process with staff about what happened and talk about ways to avoid it in the future. Itís not like we lock them in and throw away the key.I apologise if my post offended you when I said about this - I was stereotyping a little, I admit - thanks for taking the trouble to explain things to me :)

Itís regulated only a Dr. can sign the order to put them in seclusion or restraint. Even than itís only for an hour or until the pt comes down.Good - it's better than I thought, then.

If not the Dr. signs for another hour. Even with this some pts will calm down just to get out and attack someone so you have to be careful on who youíre dealing with.That I can understand... It must be quite difficult to keep on top of things, knowing that someone could flip any moment... I'm not sure I envy you, Jack =)

Some pts can't be reasoned with ether because they don't want to be or are incapable of being at that time. So what do you do in that case? Do you let them beat you up or other staff and pts what do you do? I have only been in this field for 4 months now and I already know people that have been injured by pts and can't work anymore. Seclusion and restraints aren't a punishment, but can be a deterrent. The day some of them pts wake up and figure out that they can no longer be restrained I will quit my job. I have no desire to get my eyes poked up or get bitten and have a limb broke. Some of the pts have AIDs and other diseases and will try to give that to you as well. The day when we loose that little bit of control a lot of people have said they will quit.Good arguments - for the most part, you've won me over. :)

When it's as well-regulated as it seems to be where you work, and when it's only used when absolutely necessary, then I have no problem with it, because there's clearly no alternative, unfortunately.

I still think it should be avoided unless truly necessary though, and I'm sure there are many places similar to the one you work at where conditions aren't nearly so good for the patients... But I'm glad to hear that it's not all bad out there, like I'd been led (and led myself) to believe =)

Personally I will go try out for the police department at least I can shoot back.Meh. Guns are overrated. Lightsabers are where it's at :D

But that's another discussion for another thread ;)

This was really long. I know a made allot of mistakes in there. :o In my humble opinion, this is the best thread you've ever made - and very, very interesting - thanks for posting it, and thank you for replying with such an in-depth post - it's given me a lot to think about :thumbsup:

Cosmos Jack
05-06-2003, 08:04 PM
Well nobody else is posting :giveup:

C'jais
05-07-2003, 11:37 AM
I'm with Jack.

While it could be outright categorized as inhuman, there really is no other way to keep both them and others safe, short of keeping them in a permanently tranquilized topor. I believe Jack already demonstrated this.

Keeping them drugged is even worse than having them fully conscious, IMHO.

ShadowTemplar
05-08-2003, 02:25 PM
I'm with Jack too. Not much to add to what C'Jais said. Naturally these measures are extreme and should never be used as a first-time-safety measure, but where they are unavoidable, they are unavoidable. Good thread. May it be long and healthy.