Patients see restraints as torture

The widespread use of a variety of coercive measures has a strong and traumatic impact on patients. Stronger than the psychiatric staff actually believe.

The European Times reported that studies have looked at the patient’s viewpoints of the use of coercion in psychiatric services. In a 2016 study by Paul McLaughlin of the Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development in England, he and the co-authors reported, that: “qualitative studies consistently show that coercive measures can be experienced by patients as humiliating and distressing.”

Studies make it clear that there may be very serious problems related to the use of force and coercion in psychiatry. The use of seclusion and restrain have been investigated and reported on in hundreds of publications that are available through the medical bibliographical database Medline.

Professor of psychiatry, Riittakerttu Kaltiala-Heino, carried out an analysis of the views of patients who had been subjected to the use of seclusion and restraints. The analysis was based on a review of 300 Medline publications that were available in 2004. In a lecture to the Association of European Psychiatrists’ 12th European Congress of Psychiatry she stated based on this review, that: “in all the studies that have studied patients’ negative experiences the patients have emphasized the experience that it has been a punishment.”

Prof. Kaltiala-Heino specified,

“So, many of the patients think that they have been secluded or restrained because they were punished for some behaviour that was unacceptable or because of a breaking of rules of the board. From more than half of the patients up to almost 90 percent of the patients in various studies have reported that they perceive seclusion as punishment even as torture.”

Coercion causing psychiatric symptoms

Prof. Kaltiala-Heino added, “And patients have also reported increase in a number of psychiatric symptoms including depression, suicidal ideation, hallucinations, loss of contact with reality. So, they feel depersonalized and de-realization experiences have been reported. Patients have also reported persisting nightmares in which they in kind of in their eyes are featured in the seclusion processes, the seclusion situation, the seclusion room of being locking in or tied. It can easily be traced back to the experience of seclusion or restraint.”

The use of such interventions not only may be humiliating and seen as punishment or torture, they also cause strong feeling against the psychiatric staff. In the studies patients talk about, and discuss the anger against the staff who carried out the procedure.

Patients who themselves had been secluded also felt angry and threatened when others were being secluded indicating the lasting traumatic effect the use of seclusion and restraint may have.

Prof. Kaltiala-Heino further noted, that “in most of the studies that have concentrated on patients’ experiences of seclusion and restraint, the negative experiences reported greatly outnumber the positive aspects.”

Psychiatric staff misperceive the actual negative effect

Prof. Kaltiala-Heino said, that from the review of the studies one can conclude that: “staff assumes that patients have a much more positive experiences than what patients actually have.” And she added: “The patients also report much greater variety of negative experiences and much more, much stronger feeling of negative experiences than staff assume they have.”

The misperception goes even further. Prof. Kaltiala-Heino found that: “While staff believes that the seclusion primarily helps the patients, all the patients, the other patients in the ward … when the one who is behaving in the most disturbing and violent way is removed from the interactions. And secondly it benefits the patient her or himself – the target patient. And only in the third rank it is useful for the staff. Then patients who have been secluded actually think that it is the staffs who gains the most benefit of this processes and the least themselves – the persons who was secluded, him or herself.”

Prof. Kaltiala-Heino concluded that despite the research is sporadic and the methodology used is inconsistent that they all nevertheless point in the same direction, that: “the more powerful restriction and the more coercion is used, the more negative the experiences of the patients.”