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Constraint Practices

Introduction of Coercive Practices in Mental Health

The essay focuses on the seclusion, constraint and on the restrictive practices which are used in the mental health service. It is practiced in the Australian mental health settings and to reduce the impacts on the patients (Skinner, 2015). The word "Seclusion" refers to the confinement of a person in a close place or the area that can control the movement of the consumer and from the place the patient is closely monitored. In seclusion, the free exit or roaming is prevented. As observed in the mental health care settings, when the coerced practices are used while restricting the patient to engage, it can leads to both consumers and the health care professional feeling negative about each other. Through this essay, the purpose is to understand the restrictive practices in mental health and how it can impact the consumer and healthcare practitioners. The focus would also be to understand the role of the nurse in a mental health situation and how they have to work to collaboratively with the client and to follow the national and state/ territory initiatives guidelines to minimize the restraint and seclusion. It would subsequently also controlled through utilizing a range of current national along with the international literature, that can help to understand the complication of adopting such issues.

Restraint, Constraint & Seclusion Practices

In order to control the situation, some of the practices, like secluding the patient, using the coerced forces to overpower and even purposely intervene to control the situation. Due to the excessive use of coerced practices, the interventions have become a contemporary mental health service delivery (Santis, 2015). The coercive practice like using the restraint forces and seclusion should ideally be used in an emergency situation like self-hurting or violent action and it should be one of the last ways to handle the situation. For example, in a situation where the patient has showing an increased aggressive behavior like self-hurting, showing the violent threats and even causing harm to the normal settings, the physical or the seclusion ways can help to control the situation in the mental health facilities and hospitals. The meaning of the word ‘restraint’ is to impose the restriction and also controlling the individual's freedom of movement to control or manage the person’s behavior. 

In the initial settings of the mental health systems, it was believed by the healthcare professionals, that the people with the mental ailment did not have the rational capacity to take adequate decisions (Hercelinskyj, 2019). The rational decisions in how to be treated and controlled to limited to the mental health system approach to them and enforcing the treatment. For example, some of the countries are vocal to use the limited forces of the physical restraint along with the seclusion practices that can help in controlling the patient with a mental disorder. The restraint and seclusion practices are used to control or manage agitated along with aggressive behaviors. As per the Ramluggun, Chalmers, and Anjoyeb (2018) have emphasized, on the use of seclusion that can help the self-management practices on the individual that can potentially help to manage an immediate risk along with creating self-harm to others. The perspective of the Mark et al (2015) has mentioned the role of the nurses is to work collaboratively in the mental health setting and also help in overcoming the challenges to overcome the behaviors of consumer such as violent cases, excessive aggression, manipulation and facing the issues of the self-harm and suicide.

The role of the consumers may be limited to getting a treatment, but the nurse's role is to focus on overcoming ways in the challenging behavior and the role of the personality disorder and how to handle the adjustment disorder that can cause a problematic challenge such as the drug and alcohol withdrawal(Fletcher, 2017). In the U.S, there has been approximately 10th leading cause of suicide death in 2012 and within the mental health settings, there has been 1600 inpatient who has committed the suicides in the bathrooms and the hospital rooms even though the medical staff has taken some of the precautionary measures. From the Australian Institute of Health and Welfare's (2016) perspective, there have been 269 aggressive episodes that are observed in the 2014 -2016 in Alice Springs in the mental health unit. It is also how to devise the use of physical restraint along with the seclusion (Slemon, 2017). As analyzed, the Slemon, Jenkins, and Bungay (2017) have emphasized on consumer safety and how there would be best practices to overcome the restraint and seclusion. Within the Australian healthcare setting, it is important to overcome the problem of the coercive measure which is also referred to as the ‘failure in care’. Even though there has been limited use of the coercive practice within the mental health settings.

Pros

In some of the cases, where there have been high cases of agitated, delirious patients, or some of the patients who while getting treated can show the adverse event, for example, self-extubation, then a physical restraint practice is used. Often with the use of the physical restraint practices in the USA and Norway, there have been 40% of the patients who receive it and they benefit from the critical care which they get (Dyann Ross , 2018). The most commonly used physically restrained practice is of the wrist tying up and the prolonged use of controlling the patient, while they show the self-harm or violent behaviors. Similarly, the incidents that can create harm more than to benefit, during such while the constant practices were used. In the USA, there has been an unplanned removal of the use of the invasive device which has explained how there can be restrained U.S. patients. Due to the difference in nurse-patient ratios that showed that there is only .6 percent of the nurse chances to be available for the 1.05 patient. In the mental health settings, the nurses do maintain a direct visual observation over the patient, to maintain the control. In most of the cases, the medical orders like the starting with the physical retraining are common practices and decisions taken by the nurses.

Cons

The role of the consumer is limited to experiencing negative restraint and also how there can be seclusion based practices. It can help to overcome feelings such as abandonment, anxiety and even experiencing the anger along with facing the problem of punishment, feeling scared and depressed. When the patient is isolated he/she feels anxious and there is an increased stressful condition (Royal Australian and New Zealand College of Psychiatrists, 2016). The patient can also feel negative due to the approach of using the seclusion and constraint practices on the mental health services and the measures used by the healthcare practitioner as a way to control the situation and also curb such practices. Eventually, with the higher instances of the constraint practices, people have started to protest and also working progressively on controlling the position and introduce some of the therapeutic procedures. The use of the restricted practices is also limited to the practices that can be followed by the care units detailing about the mentally retards.

Due to the extremely restrictive practices, it can even cause permanent damage to the mentally ill self-esteem and it can also make them feel so miserable that they would be adaptive to use such practices and make them part of their lives (Ramluggun, 2016). Restrictive practices can also cause increased instances of aggression leading to an impact over the mentally challenged person and damage their ability to revive up. Due to such inhuman practices, some of the restrictive and the constraint practices are found similar to treating animals (Allan, 2017). While giving such treatment, it is important to overcome some of the unethical practices which are a challenge for the movement of the consumer groups and also help handle some of the restrictive and seclusion practices that can help the individual to deal with the physical or mental damage and also harm other individuals (Australian Institute of Health and Welfare, 2016).

Role of Nurses in Coercive Practices

The nurse's role is to provide critical care and also ensure good treatment for the patients, who are experiencing a mental problem. The nurses have to abide by the clauses of the duty of the care, autonomy and using the therapeutic practices for the treatment. The patient treatment should be a collaborative approach and as per the direction of the regulatory bodies, it is important to focus on the various rules and regulations, such as using the coerced activities, forcing the patient or even using the inhuman activities. The role of the nursing staff can help to control the situation to a large extent, to overcome any negative experience. The nurse can adopt the "Model of Care" approach to control the situation. Due to the care cultures, it is important to focus on the risky specific situation and also focus on the coercive or restrictive approaches that can help to define the true nature that can likely overcome the negative interpersonal relationships (National Mental Health Commission, 2015). The main important step for the nurse is providing increased resolutions with the duty of care and practice to overcome the prevalence of challenging behaviors.

The nurse's role is to create the self-identity role and also define the practice which cares fine-tuned as per the culture, to achieve optimum care outcomes. With the defined healthcare planning and the nurse adoption of the model of care, it is important to mitigate the challenges that can help to overcome the behaviors(Moxham, 2018). At the same time, a nurse can focus on the consumer adopted strengths-based approach can also be adopted. Through consistent care and also gaining a framework of the better-instilled provision and the recipients of the care, it can help to deliver a decision based goal-oriented planning. It is essential to have a better model of the care options and subsequent outcomes. The nurses have to abide by the ‘person-centered’ or ‘patient-centered’, approach models which can help to evaluate the values and earn the respect from the persons. The nurses can work over the individual right to self-determination and through consistent mutual respect can help to overcome the challenge of treatment (Marx, 2018).

The nurse's challenges that are faced while handling the patient are of the use of the restrictive practices, which can cause the negative effects in between the nurse and the patient relationship. If the nurses are not trained to handle the mentally ill patient, it can lead to mental and physical trauma to both. The nurse has to focus on how to use restrictive practices under what circumstances and how much to use it (Muir-Cochrane, 2018). When the patient is showing the signs of the recovery plans, the nurse role is to create an effective healing process to have better outcomes.

Conclusion on Coercive Practices in Mental Health

To conclude, the use of the restricted practices is also limited to the practices that can be followed by the care units detailing about the mentally retards. Due to the extremely restrictive practices, it can even cause permanent damage to the mentally ill self-esteem and it can also make them feel so miserable that they would be adaptive to use such practices and make them part of their lives. While giving such treatment, it is important to overcome some of the unethical practices which are a challenge for the movement of the consumer groups and also help handle some of the restrictive and seclusion practices that can help the individual to deal with the physical or mental damage and also harm other individuals.

References for Coercive Practices in Mental Health Assignment 

Allan J, Hanson G, Schroder N, O’Mahony A, Foster R & Sara G. (2017). Six years of national mental health seclusion data: the Australian experience. Australian Psychiatry 25(3), 277–281

Australian Institute of Health and Welfare. (2020). Mental health services in Australia, Retrieved from https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/restrictivepractices

Australian Institute of Health and Welfare. (2016). Use of restrictive practices during admitted patient care. Canberra, ACT: AIHW.

Dyann Ross (2018) A Social Work Perspective on Seclusion and Restraint in Australia’s Public Mental Health System, Journal of Progressive Human Services29(2), 130-148, DOI: 10.1080/10428232.2018.1442972

Evans, K. Nizette, D. & O’Brien, A. (2017). Psychiatric and mental health nursing (4th ed). Chatswood, NSW: Elsevier.

Fletcher, J., Spittal, M., Brophy, L., Tibble, H., Kinner, S., Elsom, S. and Hamilton, B. (2017), Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement. International Journal of Mental Health Nursing, 26(5), 461-471. DOI:10.1111/inm.12380

Hercelinskyj, G., & Alexander, L. (2019). Mental health nursing: Applying theory to practice (1st ed., Health nursing series). South Melbourne: Cengage LearningAustralia

Kinner, S. A., Harvey, C., Hamilton, B., Brophy, L., Roper, C., McSherry, B., & Young, J. T. (2017). Attitudes towards seclusion and restraint in mental health settings: Findings from a large, community-based survey of consumers, carers and mental health professionals. Epidemiology and Psychiatric Sciences, 26(5), 535-544.

Marx, T. A., & Baker, J. N. (2017). Analysis of Restraint and Seclusion Legislation and the Policy Across States: Adherence to Recommended Principles. Journal of Disability Policy Studies, 28(1), 23–31. https://doi.org/10.1177/1044207317702069

Moxham, L., Hazelton, M., Muir-Cochrane, E., Heffernan, T., Kneisl, C., & Trigoboff, E. (2018). Contemporary psychiatric-mental health nursing: Partnerships in care. Frenchs Forest, NSW: Pearson Education Australia.

Muir-Cochrane, E., Barkway, P. & Nizette, D. (2018) Pocketbook of Mental Health (Third Edition). Chatswood, NSW: Elsevier.

National Mental Health Commission. (2015). A case for change: Position Paper on seclusion, restraint and restrictive practices in mental health services. Retrieved from: https://www.mentalhealthcommission.gov.au/getmedia/63e1d2e6-79fe-45ea-aeab-145f1d9b269a/Position-paper-on-seclusion-and-restraint

Peterson, H. (2017). Patient Abuse and Trauma: A Policy Analysis of the Regulation of Seclusion and Restraint in Mental Health Care. Journal of Policy Practice, 16(2), 187-204. DOI: 10.1080/15588742.2016.1214943

Ramluggun, P., Chalmers, C., & Anjoyeb, M. (2018). The practice of seclusion: A review of the discourse on its use. Mental Health Practice (2014+), 21(7), 17. doi:http://dx.doi.org/10.7748/mhp.2018.e125

Royal Australian and New Zealand College of Psychiatrists. (2016). Position Statement 61: Minimising the use of seclusion and restraint in people with mental illness, Melbourne: RANZCP, Retrieved from https://www.ranzcp.org/newspolicy/policy-and-advocacy/position-statements/mental-health-legislation-and-psychiatrists-putti

Santis, M., Myrick, H., Lamis, D., Pelic, C., Rhue, C., & York, J. (2015). Suicide‐specific safety in the inpatient psychiatric unit. Issues in Mental Health Nursing, 36(3), 190-199. DOI: 10.3109/01612840.2014.961625

Skinner, J. (2015). Nursing by the heart: Transformational self-care for nurses. United Kingdom: John Hunt Publishing. Slade, M. (2009). Personal recovery and mental illness. A guide for mental health professionals. UK: Cambridge University Press. Therapeutic Guidelines Limited. Psychotropic Expert Groups. (2013). Therapeutic guidelines: psychotropic. (Version 7). Melbourne Vic.: Therapeutic Guidelines

Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry, 24(4), N/a. DOI: 10.1111/nin.12199

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