Policy Research

Musing on Restrictive Practices in Mental Institutions

Photo by Andrei Lazarev on Unsplash

Today I had the immense pleasure of listening to Professor John Baker speak on the worldwide movement to reduce restrictive practices with the National Elf Service podcast.

The amount of presented occasions in which restrictive measures are warranted are actually few and far in between.

In this ten minute segment, they discuss the use of restrictive practices in mental institutions, the rarity of occasions in which the use of restrictive practices – such as situations in which the patient presents an active and immediate threat to others – is actually appropriate, and finally, the issues mental healthcare providers run into in implementing interventions that reduce the use of such practices.

When I say restrictive practices, I mean to say the use of force to restrain a patient, the use of tranquilizers, and the use of isolation rooms as a means of dealing with a difficult patient.  According to Baker, the amount of presented occasions in which restrictive measures are warranted are actually few and far in between.  In fact, in many cases it is the staff themselves who either intentionally or unintentionally escalate incidents with patients, leading to subsequent use of restrictive measures.

This is not to say that staff alone are to blame, but rather to illustrate that restrictive practices are often overused as a kind of temporary band-aid to make up for a lack of practical non-restrictive policies that staff and patients alike can depend on.  As Baker points out, engaging in restrictive practices can cause both physical and emotional harm not only to patients – against whom the measures are used – but the staff that must do the restraining, the tranquilizing, the isolating.

This is not to say that staff alone are to blame.

Listening to this podcast reminded me of my own experiences in a mental institution.  In one particular instance, I had thrown a bit of a tantrum because one of the staff had referred to me rudely and was extremely disrespectful to other patients.  In response, I sat on a table and refused to get off.

Now, in my mind – even now I suppose – I was engaging in a kind of protest.  The staff member kept using the phrase “Don’t make me ‘assist’ you,” when the onlookers and I knew that “assist” meant force.  I remember calmly saying, “Do what you gotta do, man,” and waiting.  In response to that, he had a one other staff member dragged me to my room and injected me with a tranquilizer.

The tranquilizer didn’t work and I got right back up from the bed after they put me in the room, but that’s beside the point.

I never really understood why they tranquilized me.

The point is, I knew that the only power I had as a patient was to be difficult or to be compliant.  I even knew I was being a bit of a brat.  But I had not considered that they could have just taken me off the table and placed me on a chair.  I had not considered, especially, that that may have been the better option.  I wasn’t belligerent, nor was I incoherent.  There was a marked lack of trying to understand my behavior – especially important given that the ward was run like a preschool daycare – and I never really understood why they tranquilized me.

However, there was an audience, and perhaps it was necessary to make an example of me in front of the other patients.

In any case, the presence of toxic staff makes things difficult for the rest of the staff because, in my experience, the toxic staff are also the most decisive in moments of urgency or frustration.  Once they begin to act, it becomes difficult, perhaps, to contradict their choice in front of the patients in the interest of presenting a united front.

All of this is conjecture, however my interest in the parallels between the treatment of criminals and the treatment of the mentally ill in American society, and perhaps internationally as well, fuels these conjectures and hypotheses. I hope to one day turn these scattered thoughts into founded theories of Public Policy, so that they can be used to find the very solutions Baker seeks.

I would be interested in a follow-up interview(!!!!)

…Not that you asked, but since it’s relatively on topic: I have hypothesized that it is the framing of both crime and mental illness as public safety issues first that leads to the knee-jerk, almost fear-based reaction to take away freedom and to pile on restrictions until the person with a criminal history or a mental illness is forced to “behave”,  even non-violent cases.

I would be interested in a follow-up interview later on with Professor Baker, to see what new conclusions they have arrived at regarding the reduction of the use of restrictive practices.  Not only would I, perhaps, gain some closure for my own experiences, but I believe it would give me greater insight into my own studies regarding the intersection of Civil Commitment and Incarceration in the United States.

Trauma seems to be the hidden name of the game in terms of “treating” others, or perhaps an unfortunate but necessary byproduct in the eyes of those without mental illness; I believed before, but after listening to this podcast I am certain, that there is a better way.

AKA.CLouise


The mentally ill know.
.     .    .   .  . ……………………….to imagine beyond………………………. . .  .   .    .      .


Do you have any questions you’ve been dying to ask me or any mental health topics you want me to cover? Do you have any comments or suggestions?  Let me know in the comments below!

I would love to share my experience with you! Get in touch with me if you are interested in hosting me as a speaker for your Mental Health workshop, conference, or other event.

Follow me on Twitter @akaclouise, on Instagram @aka.clouise on Facebook at/AKA.CLouise!

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