As Time Goes By: Reasons and characteristics of prolonged episodes of mechanical restraint in forensic psychiatry

Evidence suggests the prevalence and duration of mechanical restraint is particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of,... [ view full abstract ]

Evidence suggests the prevalence and duration of mechanical restraint is particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of, prolonged use of mechanical restraint in forensic psychiatry. This study therefore aimed to investigate prolonged episodes of mechanical restraint on forensic psychiatric inpatients. Documentary data from medical records was extracted and thematically analysed. Results indicate that the reasons for prolonged episodes of mechanical restraint on forensic psychiatric inpatients can be characterized by multiple factors: ‘Confounding’ (behaviour associated with psychiatric conditions, substance abuse, medical non-compliance etc.); ‘Risk’ (behaviour posing a risk of violence) and ‘Alliance Parameters’ (qualities of the staff-patient alliance and the patients openness to alliance with staff ) altogether woven into a mechanical restraint-spiral that in itself becomes a reason for prolonged mechanical restraint. The study also indicates lack of consistent clinical assessment during periods of restraint. Further investigation is indicated in order to develop an assessment tool with the capability to reduce time spent in mechanical restraint.