All persons with a mental illness… shall be treated with humanity and respect for the inherent dignity of the human person. – UN Resolution 46/119[1]
Restraints (here to also mean physical restraint, seclusion, and forced medication) are CRUEL.
Restraints used by hospitals, nursing homes and other institutions still on the mentally ill, disabled, and elderly are cruel.
Restraints are archaic, do not work, are not safe for patients or staff, and psychologically damage patients – stripping them of all dignity and the right to be involved in their own treatment while retraumatizing and punishing many. Restraints are supposed to be used in emergencies to protect the person restrained or those around them. However, even if used “correctly” and with good intention, the use of restraints is still cruel and a violation of human rights.
Physical (or “protective”) restraints are defined by the Food and Drug Administration as:
device[s], including but not limited to a wristlet, anklet, vest, mitt, straight jacket, body/limb holder, or other type of strap that is intended for medical purposes and that limits the patient’s movements to the extent necessary for treatment, examination, or protection of the patient or others.” [2]
They can include leg and arm restraints, hand mitts, lap cushions and lap trays that cannot be removed, waist/belt restraints, pelvic restraints, and vest/chest/jacket restraints among others.
The use of restraints is archaic – harkening back to times when people did not have any idea how to treat the mentally ill. Used in asylums and on mentally ill treated like criminals, restraints were thought of as treatment to subdue those thought to be out of control. In other countries, these out-dated notions remain, restraining those thought to be “criminals, crazy and dangerously aggressive people.”[3] In some places shackles and stocks are still used.
In 1797, Philippe Pinel, “physician of the infirmeries” at Bicêtre Hospital in France (then an asylum) and Governor Jean-Baptiste Pussin, freed the mentally ill (then regarded as insane) from strait jackets (though unfortunately still keeping them in iron shackles). Even they were concerned with a more compassionate approach to treating those with mental illness, knowing that restraint was inhumane. How can it be that after centuries of knowing that restraints are not humane, we continue to use them?
Today, restraints are used for the elderly and disabled under the justification that they will prevent injuries to persons who are at risk of accidental falls. Restraints are used for mentally ill and the disabled to “protect” and pacify patients. In this context, physical restraints would theoretically be used to allow a doctor to treat an individual uncooperative with treatment measures deemed necessary. In truth, they are used more as a means to control patients when staff are ill-equipped (because of lack of mental health training, staff shortages, or other reasons) to work with patients in severe distress.
Commonly accepted practice hold that restraints should not be used as the first line of intervention.[4] According to the Department of Justice (DOJ), “standards dictate that restraints be employed only in the face of imminent risk of harm, when less restrictive interventions have proven unsuccessful and never as a punishment.”[5] Yet patients are often restrained for trivial reasons such as an elderly person refusing to move to another dining table. [6] Many nurses don’t know how to recognize when to properly use restraints such as for a potentially violent situation.[7] They even don’t know that there are alternatives to restraints or that restraints can kill.[8]
Laws exist to protect individuals from restraints. The Nursing Home Reform Act specifically states the following requirements for those in institutions:
(A) Specified rights: A skilled nursing facility must protect and promote the rights of each resident, including each of the following rights: …
(ii) Free from restraints The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms. Restraints may only be imposed—
(I) to ensure the physical safety of the resident or other residents, and
(II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used (except in emergency circumstances specified by the Secretary until such an order could reasonably be obtained). [9]
Nursing homes accepting Medicare or Medicaid payments must care for residents “in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.”[10] Yet, in applying restraints, residents’ feel socially isolated, fearful, demoralized, humiliated, angry, uncomfortable, and confused – feelings that remain months or years after restraint removal.[11]
Courts have found that institutionalized persons have a legal right to “freedom from bodily restraint”[12] The American Medical Association likewise states that “All individuals have a fundamental right to be free from unreasonable bodily restraint.”[13] The AMA emphasizes the need for informed consent and restraints should not be punitive or used for convenience or used because of inadequate staffing. Still restraints are used, and they are used liberally and inappropriately to certain cruelty.
[R]estraints – with their inherent physical force, chemical or physical bodily immobilization and isolation – do not alleviate human suffering. They do not change behavior. And they do not help people with serious mental illness better manage the thoughts and emotions that can trigger behaviors that can injure them or others. [R]estraints are safety measures of last resort. They can serve to retraumatize people who already have had far too much trauma in their lives. – Charles Curie, Administrator of Substance Abuse and Mental Health Services Administration [14]
Restraints do not keep people safe.[15] In fact, each year approximately 150 deaths occur nationally due to restraints.[16] Beyond deaths, restraints can cause pressure sores, higher rates of infections, higher rates of falls, contractures, incontinence, bone demineralization, and increase aggression in both patients and staff among other effects.[17] Restraints do not protect the elderly from falls or fall-related injuries.[18] Staff are also hurt by restraints with studies showing that for every 100 mental health aides, 26 injuries were reported.[19] Not to forget that restraining patients has a psychological impact on nurses.[20] Thus, Restraints do not ensure physical safety, and there is no reason to ever use them for as it is a violation of legal rights.
Abuse has widely been documented about the use of restraints. In 1998, the Hartford Courant published a series of investigations on the use of restraints, confirming 142 deaths during or shortly after restraint or seclusion in mental health or mental retardation facilities (noting that many deaths may not have been reported).[21] They found that the aides who execute most restraints were the least trained and lowest paid in their field.[22] They also found that because of poor oversight and legal recourse, few were punished for their misuse of restraints.[23]
Following this report, the National Alliance on Mental Illness (NAMI) started tracking reports of restraints and seclusion abuse, producing a report of 58 such incidents in only 2 years including the following disturbing incidents:
- A Man asking for something to help him sleep and was placed in seclusion with no bathroom, left to defecate in his clothing
- A Man admitted to psych ward involuntarily through ER after calling 911 for help was given antipsychotic drugs despite lack of consent and denied sleep medication even thought it was prescribed. He became agitated and hit an exit sign at which point staff told him that if he would go into seclusion room he would not be restrained. He cooperated but was still put into restraints in seclusion for 12-14 hours; during which time his charts showed he was calm and cooperative
- A 12 year old boy died at a wilderness camp when placed face down in a physical restraint.
- A 9 year old girl was left in a “time-out” room for three hours where she screamed, when the girl did not quiet down she was then placed in a therapeutic hold, and then given four shots of a sedative. The parents had no idea.
- A 44 year old professional woman sought voluntary treatment for bipolar disorder and was placed in 4 point restraints
- A man was kept in seclusion and sometimes in restraints for 10 days, because staff said that he “needed to sleep” instead of pacing at night and that he was not acting “appropriately.”
- A 28 year old woman voluntarily committed for treatment of conditions related to child abuse including rape was put in restraints with padlocks.
- A woman was given medications for 3 days until she was found “semi-comatose on the floor.” They placed her in restraints and stopped all meds and she woke up 3 days later unable to talk. She continued in the hospital for 3 weeks without counseling or rehabilitation.
- A 9 year old boy died after two hospital workers pinned him to the floor during a violent struggle.
- A 16 year old girl died while in restraints from a heart condition.
Most of those reported were in hospitals, residential facilities, or mental health institutions. These likewise happen to the elderly as evidenced by several court cases.
In Saunders v. Beverly Enterprises, a 56-year-old terminal cancer patient, a known smoker, was admitted to the defendant’s nursing home with orders for bed rest and restraint as needed.[24] He was restrained 24 hours a day.[25] He later obtained a lighter and tried to “burn himself free from the restraints, setting himself on fire.”[26] Two weeks later, the hospitalized man died from second and third degree burns to his torso and neck.[27]
An 84-year-old resident who had been restrained in her bed with a vest-type restraint was found hanging from the side of her bed strangled.[28]
Then there is the 2008 report by the DOJ on the conditions in Texas’s State Schools for the Developmentally Disabled finding a failure to provide freedom from unnecessary or inappropriate restraints.[29] From January through September 2008, a total of 10,143 restraints were applied to 751 Facility residents.[30] The year before on resident’s shin bone was broken while forced into restraint after the resident did not answer what he wanted to eat and became agitated when staff touched him.[31] That same year a teenage resident of one Facility died while being held in six-point restraints.[32]
These examples are a few of the many sad tales of restraint abuse. Yet still these restraints are used frequently upon our most vulnerable – mentally ill, elderly, and disabled – those most in need of compassion and help. In 2008, a 26 year-old woman was placed in restraints for asking to discuss with her doctor the need to take a certain medication. The doctor never discussed the matter with the patient and she was put in 4-point restraints with an NG tube forced down her esophagus. She was left in this state for hours while nurses laughed at her in the hallway.
Regrettably, those who are restrained are seldom listened to. Their experiences are ignored even when these restraints are used “appropriately” (restraints are never appropriate but as deemed acceptable under today’s standards). Few studies have addressed how it feels for a person to be restrained. I recently came across an article by Tania Strout – Perspectives on the experience of being physically restrained: An integrative review of the qualitative literature. She found that restraints had a negative psychological impact, retraumatized those restrained, and were perceived as unethical. Common themes in the restrainees’ perceptions arose, including:
- Humiliation
- Demoralization
- Dehumization
- Degradation
- Embarrassment
- Violation of personal integrity
- Vulnerability
- Imbalance of power with the restrained feeling powerless
- Restraints used as a means of punishment and control
- Retraumitization inducing flashbacks, nightmares, and anxiety related to prior abuse experiences
- Increased distress even after the restraints were removed
- Increased anxiety, fear, and anger, helplessness
- Lack of concern and empathy[33]
She additionally found that there were perceptions of
- Lack of communication prior to restraint
- Being for refusing treatment, following staff directions, or loss of control
- That many were just trying to defend themselves[34]
How sad it is to hear these accounts by those restrained – particularly when alternatives exist.
If worried about falls, institutions can work to identify each individual’s risk factors for falling and target their interventions accordingly such as addressing medication side effects, observing residents, facilitating safe mobility and transfer, rehabilitative programs, etc. Institutions can implement exercise programs to improve strength and balance.
For others with mental illness or disability, institutions should focus on communication between staff and patients. This alone could abate many circumstances which may escalate because of misunderstanding and leave a person feeling defensive and scared. As with those in nursing homes, mentally ill or disabled should have more individualized treatment assessing and recognizing triggers that may make someone more agitated, being aware of early warning signs and symptoms, implementing crisis plans and post crisis plans. Proper education for staff including doctors, nurses, and assistants in all areas of care from emergency rooms to residential treatment centers should focus on helping providers understand mental disorders and disabilities. Of course increased staffing would also help to ensure more individual attention on each person and eliminate the use of restraints as a means of control.
The Substance Abuse and Mental Health Administration states that eliminating the use of restraints requires:
- An adequate number of qualified staff to meet patient treatment needs
- Staff training, especially in verbal crisis management, including de-escalation techniques
- Active treatment
- Active risk assessment and risk-based treatment planning
- An environment of care that promotes patient comfort, dignity, privacy, and personal choice
- An emphasis on recovery for the mentally ill [35]
Most cannot imagine the horror of being restrained – the degradation, humiliation and pain of restraints. These methods are as cruel as use of frontal lobotomies or electro-shock therapy. They are torture for the patient and ultimately result in incredible physical and mental harm, harm which they are ironically meant to prevent. Still they are used under ridiculous justifications. Perhaps people do not understand the seriousness and think the call to end restraint use as an overreaction to a few bad examples. As the author of One Flew Over the Cuckoo’s Nest (most remembered for its portrayal of a mental hospital/ward and damning the use of frontal lobotomies) stated regarding his book and play, “And to those who think it is fictionally exaggerated I only say try it first and see.” [36]
It is no exaggeration to state that restraints are cruel punishment for the most vulnerable. If you think otherwise try it first and see.
See also:
GAO reports,
- Mental Health: Improper Restraint or Seclusion Use Places People at Risk (GAO, 1999a)
- Mental Health: Extent of Risk from Improper Restraint or Seclusion is Unknown (GAO, 1999b)
SAMHSA website on Seclusion and Restraint
Mental Health America’s Position Statement 24: Seclusion and Restraints
Child Welfare League of America
One final note – Apologies for the dismal citations!
[1] United Nations General Assembly Resolution 46/119: The protection of persons with mental illness and the improvement of mental health care. http://www.un.org/documents/ga/res/46/a46r119.htm, accessed 5/29/11.
[2] 21 CFR Section 880.6760
[3] Minas, H. and Diatri, H., Pasung: Physical restraint and confinement of the mentally ill in the community. International Journal of Mental Health Systems (2008); 2: 8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442049/ accessed 5/29/11.
[4] Redl, F. & Wineman, D. (1952). Controls from Within: Techniques for the Treatment of The Aggressive Child. New York: The Free Press.; http://www.samhsa.gov/Seclusion/SR_Report_May08.pdf
[5] Report by the US Department of Justice regarding statewide CRIPA investigation of the Texas State Schools and Centers. December 1, 2008. http://www.justice.gov/crt/about/spl/documents/TexasStateSchools_findlet_12-1-08.pdf, accessed 5/29/11.
[6] US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Summary Report, A National Call to Action: Eliminating the Use of Seclusion and Restraint, May 5, 2003. http://www.samhsa.gov/Seclusion/SR_Report_May08.pdf, accessed on 5/29/11.
[7] Supra, note 6.
[8] Id.
[9] 42 USC 13951-3(c)(1)(A)(ii).
[10] Id. & 1396r(b)(1)(A) (Supp. IV 1998) [Medicaid]; 42 C.F.R. 483.15 (1999) (featuring slightly different language — “A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.”)
[11] Kathy A. Gorski, Myths & Facts … About Physical Restraints and the Elderly, 25 Nursing 25 (1995).
[12] Savidge v. Fincannon, 836 F.2d 898, 906 (5th Cir. 1988) (finding that Youngberg v. Romeo, 457 U.S. 307 (1982) recognized that an institutionalized person “has a liberty interest in ‘personal security’ as well as a right to ‘freedom from bodily restraint.’”)
[13] American Medical Association Code of Medical Ethics, Opinion 8.17: Use of Restraints. Adopted June 1989. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion817.page, accessed on 5/29/11
[14] Conversation with Charles Curie, SAMHSA Administrator (2002). See also Curie, C. “SAMHSA’s Commitment to Eliminating the Use of Seclusion and Restraint.” Psychiatric Services 59(9):1139-1141 (2005). http://www.mentalhealthamerica.net/go/position-statements/24, accessed on 5/29/11.
[15] Braun, J. and Capezuti, E., Article: The Legal and medical aspects of physical restraints and bed siderails and their relationship to falls and fall-related injuries in nursing homes. 4 DePaul J. Health Care L. 1 (Fall, 2000). (noting that no clinical study demonstrates that any intervention, including restraints, unequivocally prevents falls or fall-related injuries, that “one-half of all falls occur among restrained [residents]” and “serious injury rates are higher in facilities that use restraints”).
[16] Supra, note 6.
[17] Perspectives on the experience of being physically restrained: An integrative review of the qualitative literature. 19 International Journal of Mental Health Nursing 416-427 (2010).; Braun, J. and Capezuti, E., Article: The Legal and medical aspects of physical restraints and bed siderails and their relationship to falls and fall-related injuries in nursing homes. 4 DePaul J. Health Care L. 1 (Fall 2000).
[18] Perspectives on the experience of being physically restrained: An integrative review of the qualitative literature. 19 International Journal of Mental Health Nursing 416-427 (2010).
[19] Supra, note 6.
[20] Supra, note 18.
[21] Weiss, E. et. Al. Hundreds of the nation’s most vulnerable have been killed by the system intended to care for them. Series: Deadly Restraint, A five-part series. Hartford Courant A. 1, October 11, 1998.
[22] Id.
[23] Id.
[24] Saunders v. Beverly Enters., No. 89C-10930 (Marion Cty. Ct. Or. filed Mar. 18, 1991).
[25] Id.
[26] Id.
[27] Id.
[28] Green, W. & Pollack, E., Nursing Home is Liable in Restraint Case, Wall St. J., Mar. 26, 1990, at B5.
[29] Supra, note 5.
[30] Id.
[31] Id.
[32] Id.
[33] Supra, note 18.
[34] Id.
[35] Supra, note 6.
[36] Kesey, K. letter to New York Times, January 7, 1964. http://www.lettersofnote.com/2011/05/it-can-never-be-as-bad-in-fiction-as-it.html, accessed on 5/29/11.
Health as a Human Right 
wow, powerful post!
I am grateful for this article. I have been placed in a straight jacket, two-point restraints, four point restraints, handcuffed, and secluded while receiving “treatment” in various California psychiatric units. As a result of this punishment for being ill, I experience post traumatic stress disorder.
I am so sorry to hear this! How cruel and unfair. Please know your voice is heard and I am thankful you would share this to let others know.
Wow, my dad with severe Alzheimers was admitted to the hospital this week, within 1 1/2 houirs that a family member was not there he got confused and agitated, when a family member arrived he was in bed urine soaked pants, laceration on head, severe contusions on arms. Never did a hospital doctor or nurse call to inform the family.
I am so sorry to hear that! Is he doing ok? We definitely need to change this!
Thank you so much for this article. I suffered a nervous breakdown in 1990 after returning to England after 4 years of living in Jamaica. I had just turned 22 years old and I arrived in England alone. A few months later I was voluntarily admitted to a psychiatric ward and shortly after my admission I was restrained by a male nurse. I was forced face down to the floor with my hands pinned behind my back and forced to stay in that position because the nurse had squatted down with one knee on my back. Whilst there, another nurse stabbed me with a medication-loaded needle in my buttock. ( I use the word ‘stabbed’ because the injection was a brutal one.) When I came to, I found myself in a padded cell alone. My tongue and lip were busted, heavily swollen and bleeding. When the nurse had restrained me, I hit my chin very hard on the floor as I fell and had caught the tip of my tongue between my teeth. Yes, excruciating! Added to that, the pain in my buttock (from the injection) lasted for around two weeks; the swelling (abnormally hard to the touch and about the size of a table tennis ball) lasted several months.
A concerned health worker who was visiting the ward at the time heard the other patients complaining about my plight and asked me to write a recount of the incident, which I did. I handed it to a nurse who I deemed trustworthy as instructed by the health worker. Two days later when the health worker came back to the ward to collect my recount, lo and behold (yes, you’ve guessed it!) the potentially damning report had vanished and the ‘trustworthy’ nurse had “no recollection” of me even handing it to her!
I have been restrained two times since that particular incident, once by the Jamaican police on a visit to see my parents on holiday. I had refused to take the medication prescribed by a local doctor after I became agitated. He then warned me that if I did not comply, the matter would be taken out of his hands; all authority concerning my welfare would be given to the police who could cart me off to the psychiatric ward of the local hospital. Once there, he, the doctor could have no jurisdiction over the medication administered. I still did not comply and so he injected me with a sedative in front of at least three male police officers. (N.B. I was bent over the dining table as one of the officers placed handcuffs on me ” just in case” I resisted the administering of the sedative. As usual the injection is given in the buttocks so the doctor exposed me to unnecessary humiliation.)
The final shameful degradation of a young CHRISTIAN sister
came later that evening when I was frogmarched by two of these police officers to a waiting police car. I was bundled into the back seat of the car in front of a large crowd of my parents’ neighbours and other giggling onlookers and driven at high speed to the hospital.
In spite of it all, I am still alive to tell the tale and hopefully show others that even in hell on earth there is a chance of escaping with ALL your ‘faculties’ still in tact.
I am now a teacher. I will always be a SURVIVOR. If people don’t believe how insanely vicious and demoralising physical restraint of the vulnerable in society is, then I join with the author of ‘One Flew Over the Cuckoo’s Nest’ when I too admonish, TRY IT FIRST AND SEE! However, if you don’t get through it alive, you can’t turn up at ‘the gates’ (of hell, that is) with your pompous, heartless opinion claiming that you weren’t warned!
Thank you for sharing your story. How brave to be so open about your history. These stories will help others to understand and help those who have experienced this pain to know they are not alone.
Best wishes for continued improved health. I hope you will not have to experience such pain again.
I have been working in a healthcare setting for most of my career now, in a security setting and what I will say is this. I would rather place someone in restraints and keep them as well as others in the area safe from violent and aggressive behavior. This article is ridiculous. It is neither cruel nor painful and is only used as a measure to prevent violent behavior and injury.
My Grandmother had Alzheimers before she passed as well and was often put into restraints as her mind began to detioriate. People have a right to protect themselves and feel safe. Particularly those in professions where dealing with the mentally ill and/or violent persons is regular occurence.
Its alwats easy to sit back and judge others actions for protecting themselves, until you are in the violent situation. People’s song and dance like this one tend to change when its them confronted with the violent behavior.
I am so sorry for your grandma that you would have let that happen to her. How awful that must have been for her.
I think you too judge to quickly. Perhaps you have never been restrained?
Try working in a hospital/center/center based school were you are physically assaulted, spit on, bit, kicked, head butted, slapped and have had feces smeared in your hair. This article is obviously written by an individual with very limited experience working with a severely disabled or mentally ill population. It is preposterous. The use of restraint has probably saved my life. The fact that legislators possibly listen to this kind of nonsense and act blindly to outlaw this practice is sickening. Better a bump, bruise, laceration, stitches or a broken bone than a lobotomy. Without the use of physical restraint in certain professions, we might as well go back to the days of medicating violent individuals until they are comatose.
Thank you for your point of view. I do have experience with these populations and as a result I have come to this post, which I took great care to research. Please provide me with further research if you wish to refute my writings.
I totally agree with Mike!! I work in an all MALE, FORENSIC, PSYCHIATRIC facility. The guys I work with have killed their own mothers and have no remorse for their actions. This article shows an inexperienced individual when it comes to horrific violence that can be displayed within a locked down psychiatric unit. I invite you to come and spend a day with my support team and see if you would still go “play” with these guys and survive. We have literally SAVED lives using restraints! I believe that when restraints are used CORRECTLY it is a means of protection from harm including the patient that wants to slit his own throat and will use whatever means necessary to carry these actions out. I invite you to come to our facility and be on the unit when a riot breaks out and do nothing to save anyone around you…including yourself. Maybe that would change your mind. RESTRAINTS SAVE LIVES…INCLUDING THE PATIENTS LIFE!!
I have spent time on many locked psychiatric wards with men who have lashed out. I still think restraints are cruel.
I would rather have both my eyes and my neck skin intact rather then having a patient NOT be placed in restraints. We can agree to disagree.
I have worked in a state mental health facility, a forensic facility, and currently in a psychiatric emergency unit, having started my career inn medical/ surgical nursing. I deplore the use of restraints, chemical and physical, and am the last person to approve a use on the unit.The writer seems to deny the existence of people that are physically and uncontrollably assaultive (and restraints should rarely, if at all, used in any other circumstance). sometimes completely responding to internal stimuli demanding that they hurt people I can assure you they do exist. Some people are brought in by the police in such an uncontrolled state, and no amount of verbal de escalation is successful, and the patient seems unable to perceive the words being conveyed. In the state facility, at least half of the staff has at one time been injured by a patient. One story that stands out was a woman walking past a room on night rounds had a patient jump out behind her, grab her by the hair, and slam her back of the head first onto a hard floor. She sustained a traumatic brain injury and was permanently disabled. At times the patient will also injure themself or other patients as well. I agree chemical and physical restraint are sad choices. but sometimes they are the only choices left to prevent severe injury or death. I am constantly searching and researching other options, and will be overjoyed when these options become outmoded. I go home with a heavy heart for people whom’s lives have become interrupted or disrupted by mental illness, usually do to no fault of their own, but we are charged and burdened with their, the other patients, staff and visitors safety, as well as the therapeutic treatment of those in need. There is literature out there that supports the use of restraints, and I think a good analysis should explore the pros as well as the cons. and not be one sided.
First, let me say that I am sorry for the pain and trauma suffered by you and your colleagues.
Thank you also for your care and concern for those who suffer with mental illness. I am heartened to hear the compassion you have.
That said, it was disheartening to read your thoughts “we are charged and burdened…” Burdened. What a word to use and one I recently wrote about. That word is so laden with the pain many of us with mental illness feel – that we are a burden, unwanted by society. It is a painful truth that we are seen in such a light – burdens. I hope one day you will see that you are not burdened but perhaps for some, you are privileged to have the ability to bear witness to our lowest moments and to help us heal. We did not choose this as you recognize, but you choose to work in that environment and so I hope to believe you do it out of compassion. Compassion is hard, especially when you feel unsafe and have seen others hurt. But I beg of you to hold it for us all.
As to a more balanced argument, as a lawyer and scholar I did research this issue and I presented it as such because I believe it is the right argument to make. I do not believe in the use of restraints. In saying this I do not “deny the existence of people that are physically and uncontrollably assaultive.” I understand these case, have witnessed these cases. I hold by my argument that restraints are cruel. I am trained to look at both sides of an issue and consider them deeply. I do not come to my conclusions lightly. I am glad that you agree they should rarely be used and I understand your reasons for believing in their utility, but I stand by mine. In part, I stand by this because it is a slippery slope to say they should only be used in “uncontrollably assaultive” cases. That is not an easily definable term and it is misinterpreted by many. It leaves in the hands of another the ability to either take advantage or to make decisions that put a vulnerable person at great risk of harm. Who decides what is uncontrollable and unsafe? I would argue if we are left to that standard, too many will continue to interpret it liberally at the expense of those who who have no one to advocate for them. I can name many instances of harm to a patient inflicted by providers under the auspices that they are some how out of control. It too leaves scars that last a lifetime both mentally and physically. It hurts those who are already hurt, and often can perpetuate the very symptoms which led them to that situation.
That said, I think we are both on the same side here, not adversaries in our beliefs about the use of restraints. I think you understand how they can be cruel. More importantly, we both acknowledge we must continue to seek better options for mental health treatment – options that are more humane, safer for all, and lead to healing. And having these discussions, I think, will continue to lead us in that direction.
Obviously, you have never been strapped down overnight because of an anxiety attack. You are unintelligent man who doesn’t seem to have any compassion. Quite your job.
Restraints are such a scam. They’re just an excuse for bullies to bully and harass people repeatedly and at zero risk to the bullies/aka workers. Hospitals get away with it because they are “official” or whatever, and they attack perfectly normal citizens often and repeatedly. Personally, I think that the people putting people in restraints should go to jail for endangerment, harassment and aggravated assault. Maybe I’ll do that….:)
I have been diagnosed with schizophrenia for many decades but in the winter of 2013, I was hospitalized at a well-known psychiatric center in Connecticut in the United States, Hartford Hospital’s Institute of Living, against my will, for a month. There, for nearly three weeks of my stay, I was kept in a tiny “side room.” They insisted this was not seclusion, though the definition of seclusion is any room or area from which a person is forcibly prevented from leaving. Repeatedly they put me into tight leather 4-point restraints because I “did not follow directions.” I defecated in my clothing but they kept me in these restraints for as long as 20 hours, despite falling asleep and sleeping for hours. In my chart, which I recently read, they recorded that at one point I asked in a soft voice and sedated, “could you let me out of these things?” meaning the shackles. But they refused. The fact that they would tell me to lie down on the restraint bed, and that it would take only a single female nurse to restrain me, says it all: I was not in imminent danger of physical harm to myself or to anyone else. I WAS however terrified to resist lest the goon squad descend on me and hurt me even more than they already had.
The nurses at this same Connecticut psychiatric hospital in 2013 implied they restrained me repeatedly as punishment by saying the opposite: “This isn’t punishment, Pamela, it is only what your behavior brings on every time.” But what did I do? I walked away from the “side room” that the nurse had just told me wasn’t a seclusion room. I walked down the hall, looked out a window, and when asked to, calmly walked back. That was when they restrained me as discipline for my leaving the “non-seclusion” seclusion room. By the way, I was attacked, held down and injected multiple times in the buttocks, with multiple drugs, even when I was calm, and in restraints, just to put me back to sleep, though I had been asleep, already in restraints. When I got home, I photographed the serious bruises I had sustained from such treatment, but no one cared. This is illegal but nobody in Connecticut gives a damn about older adult mental patients who are restrained or forcibly medicated.
Then this spring, at New Britain General Hospital, even worse happened when security guards were allowed to strip me naked, place me in a barren, freezing cold seclusion room, more stark than a supermax prison cell, and when I objected, four point me, still naked, to a plastic mattress. I was left alone to scream my lungs out, the intercom turned off so no one would have to listen to me, only an aide stationed OUTSIDE the closed door, sound proof room, who was not permitted to speak to me, tell me the time or answer my questions or even get me a blanket.
This was when I understood that I had to leave this state I have lived in all my life. Connecticut’s treatment of the mentally ill is so barbaric that it has gotten worse than it was two decades ago, and is worse rather than better because of “Deadly Restraints”. I am moving to Vermont.
I am so very sorry to hear of the pain and suffering you’ve endured. I commend you for your bravery in writing your experiences here to share with the world how awful restraints are both physically and mentally to those who need compassionate care. I do hope that in your move and wherever you may go in life that you will find better care, that you will find providers that will listen and work with you, and that you will never be so violated again.
I am from the UK and I only learned a few weeks ago that women having C sections in the US are strapped down to the operating table both their arms and legs are actually strapped down during the OP. This is not done at all here in the UK and is illegal but apparently in the US this is standard practice in many hospitals. Since when is a pregnant woman who consents to a C section such a danger that she needs to be tied down?
Yet US health and childbirth groups have done nothing to stop this barbaric practice which is just as bad as putting people in 4 point restraints.
I called 911 the other night for help ( was being physically abused by my spouse ). When two sheriffs deputies arrived and I explained my situation and fear they ultimately handcuffed me, I didn’t put up a fight but willing placed my hands behind my back. They then called an ambulance that arrived and put me on a stretcher, restrained me and took me to the hospital. The hospital used 8 staff members to transfer me to a hospital bed, and once again used the 4 point restraints while all hand were roughly holding me down even though I was NOT and never was putting up any resistance. I was cooperative!!! I was never combative or physically abusive to any one …. After restraining me, one of the nurses removed my clothing in front of ALL eight people and put me in a hospital gown. It would take pages to recount all the humiliation and inhumane treatment I experienced.. Wasn’t allowed to get up to use the toilet, so urinated in the bed several times and was left in the wet bed for over an hour. Bottom line, I need a good, qualified, compassionate attorney in the Seattle area to represent me. I can’t erase or undo my experience but want to make certain no other human is subjected to such humility at the hands of ” healthcare professionals”! I was treated like an animal by an institution that supposedly provides health CARE!!! Swedish Hospital, Issaquah you should be ashamed!!!!!!
Thank you so much for your article. I can’t tell you how much it means to me that you condemn restraints as cruel and stand against them unequivocally. Many years ago, I was restrained (four point) and forcibly drugged for days on end in a psychiatric ward. This violation started because I was in a terribly frightened state and trying to run out of my hospital room. Before the “intervention,” no one talked to me or approached me in the least. Had someone engaged me in a respectful, open manner, or tried to comfort my fears, this would’ve been like a godsend to me. In any case, I can only describe the experience of being restrained as torture. The harsh leather restraints, that gripped me so tightly, were very painful, cutting into my skin continuously. The experience of being powerless to move in the least was terrifying. I kept screaming to be released and for “help” (in a hospital of all places) and the staff entirely ignored me or came to drug me–more and more and more.
So as to shut me up and shut me down. The whole experience felt like warfare on my body and being. When I emerged from the ward, deeply traumatized and enduring all kinds of flashbacks and night terrors from this so called “help,” I spoke out against what had happened to me… I called the restraints and forced drugging torturous and inhumane. Nobody listened–except thank God my boyfriend and a few random people here and there. The world’s silence in the face of my testimony became as traumatic as the horrible treatment I endured in the psych ward. I felt entirely unsafe for years and years (and suffered PTSD) b/c in addition to being traumatized by my experience in the restraints, I felt the nightmare could happen again because restraints are seen as “help.” No one was protesting it. There was no law against it to keep me safe. Everyone was discounting my testimony. I think that because I was “psychotic” when I was strapped down, I was so deeply othered and nobody saw me as a real person within the ward or outside the ward.
I feel entirely alienated from my so called liberal community–who protests all sorts of injustices, but who ignores this particular violation of human rights which I tried so hard to expose to them. Screw them all! I know the truth, and I have never turned my back on it.
Thank you again for seeing people who are commonly written off as “violent awful” people (and yes I saw the postings above and how well you kept your cool in responding to them) as human beings who deserve to be treated with as much respect as anyone else! People like you are indispensable. Please keep fighting this fight. We need you ever so much!
Thank you for sharing your story. I am so sorry you experienced this and know that it creates its own trauma after you’ve already endured so much. I am glad that some listened and believed your story but it certainly isn’t enough. I too find it more than disheartening that most, even liberals as you say, don’t understand or recognize this issue. You are right that everyone deserves to be treated with respect, and I’d argue that those struggling with mental health need even more compassion than most.
Know that I hear your story and my heart goes out to you as you continue to heal from the events you suffered.
I’m sorry to be so long in getting back to you–but I wanted to thank you so much for your kind and supportive response. And yes, I think you make a great point in saying that “those struggling with mental health need even more compassion than most.” I think that people struggling with mental health are in a particularly vulnerable position, and just when they need a loving hand and heart extended to them, they are all too often treated with prejudice and brutality (especially in public hospitals).
I’m wishing you all the best, and I thank you so much for your incredible advocacy!
[…] a shaming/blaming tone for his displayed behavior. Many outsiders question if this is against the patient’s human rights , but, hospitals claim it is for the good of the patientfor since they need to be taken care of […]
Hi again, I just forgot to enter the the “notify me of new comments via email,” in my last post, so I’m writing this so I can check that box now. Thanks!
I think as you point out it can be used too often. People in authority can overuse power. There is an inquiry into the use of restraints on children in detention currently because of graphic videos publicly released. I think giving injections were given out too regularly at one of mental institutions I went to. I got one & theday didisappeared. On three occasions I was pinned down by 6 burly male nurses using pressure points. The last occasion they said they nearly broke my leg & now my knee is weak & sore. I’ve been in the locked room & could only come out when I agreed t9 have my medication. Is it ever legitimate to use restraints? I would suggest yes, maybe some of the occasions I had it. I don’t know….
I’m so sorry you went through that. I don’t think it’s ever okay to pin someone down. The physical harm you suffered is terrible and I know the emotional pain can be much deeper. I hope that you will heal in time and I’m thankful that you would talk about what happened to you.
Thank you for empathy. Yes they remain shocking events to me. Totally powerless.
[…] a shaming/blaming tone for his displayed behavior. Many outsiders question if this is against the patient’s human rights , but, hospitals claim it is for the good of the patient for since they need to be taken care of […]
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