Hi everyone. Today, it’s time for my letter R post in the #AtoZChallenge. I didn’t know what to write about for this post, so I looked at some books for inspiration. Then, the topic of restraints came up. This is quite a controversial one and sadly restraint and other restrictive measures are still commonly used here in the Netherlands. At least here at my current care home.
In the Netherlands, in 2020, the Care and Force Act replaced the law on exceptional admissions to psychiatric hospitals that previously regulated restrictive measures. Under the old law, only those involuntarily committed to care facilities or psychiatric hospitals could be subjected to restrictive measures against their will. This was not to say people weren’t pressured into consenting to restrictive measures. For instance, when I had been at the locked psych unit for a few months in early 2008, I was significantly dysregulated. My doctor told me she was implementing seclusion and, “if it doesn’t work, we’re going to file for involuntary commitment”. She should have said “if you don’t consent”, but I had no idea I even had a right to consent.
Under the Care and Force Act, anyone receiving care can be subjected to restrictive measures, which are euphemistically and rather incorrectly called “involuntary care”. Yes, even people receiving care in their own homes. And like I said “involuntary care” usually isn’t care at all, but are measures to restrict someone’s freedom, often in the absence of appropriate care. For instance, if a person with dementia lives independently, they can be involuntarily prevented from entering their own kitchen if they’re a risk of leaving appliances on.
I don’t know the exact criteria for people to be subjected to restrictive measures. It has to do something with risk of significant detriment to the client or others. I was, at my old home, subjected to some restrictive measures. For instance, several doors were locked at night because I would enter those areas (eg. the kitchen) and be a danger to myself there. Here at my current home, the door to the living room and all entrances are locked at night anyway and have been from before I came here. I do know at least one fellow resident is locked up in her room at night. This, to me, feels a bit unfair, particularly because there’s no night staff directly available and the ones in the main building usually just tell us to go back to sleep when we press the call button.
Restraint specifically – restricting someone’s physical movement – is also commonly used here. I, thankfully, have only been physically dragged by several people a few times and was never shoved to the ground or forcibly held in position.
The author of the book I read, which is a parent’s guide to autism, recommends not reacting to a disabled person’s meltdown at all unless in such a way absolutely necessary to keep them and others safe. I am not sure I agree, since honestly I don’t feel that many people with developmental disabilities do have the self-regulation skills necessary to calm themselves. In my experience, “crying it out” will not teach them those skills, but will teach them that you’re not available. In the same way, I honestly don’t feel that someone will actually have a meltdown just so they can be restrained, as the author claims. I, honestly, have never felt that having my movement restricted was comforting.
A Multitude of Musings 
Restricting people against their will can have serious consequences. Only in case of apprehension of self harm it should be considered
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Agreed. I do understand that it’s necessary in some cases to physically prevent someone from harming themselves or others. That being said, I honestly feel that in the current age of massive budget cuts to care, restrictive measures are becoming more widespread. I mean, I was never physically aggressive back in the psych hospital and the reason for my seclusion was that I screamed. Furthermore, a staff told me once, literally, that I’d be secluded if I “need more care than we can provide”.
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That is a very harsh way to treat people.
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What a thoughtful piece–and a disturbing one. The theory that people freak out deliberately just so that they can be placed under restraint sounds like an absurd justification. On the other hand, if you are only told to go back to sleep when you call for support, you may act out so that you actually get some support. But I agree: restraint doesn’t sound like support to me either, it sounds like punishment.
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I agree particularly about your last point. Although back under the old law, at least restrictive measures couldn’t be used as punishment, only to avert danger, it was in my treatment plan that seclusion was meant to “give me back the responsibility for my behavior”. In other words, staff would threaten seclusion so that I’d shut up. This was illegal, but what did I know?
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In my opinion we should be using the term ‘assault’ when talking about the use of force to restrain or coerce a person in a care home or psychiatric unit who is not threatening imminent harm. I have heard too many stories about people, including women and young girls, being set on by groups of staff, including men, for reasons that would not come close to justifying such actions in the outside world. In the UK there is a certain amount of pride in the fact that mechanical restraints are almost never used, but I read that mental health professionals react with horror when told that assault restraints, pinning down a patient who is in distress and injecting them, happens a lot. We also have units that deprive patients of things that make life bearable, such as books, pens (or even pencils and crayons) and mobile phones, and keep people who are on a normal psychiatric ‘section’ with people who are on a forensic section and thus are subject to the same restrictions.
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I agree wholeheartedly! And to be honest, it’s not just in the psychiatric system. Here in the Netherlands, in the over nine years that I was in psychiatric hospitals, I was physically dragged to my room by staff once, put into seclusion (solitary confinement) against my will once and forced to be transferred to the locked ward for a few hours twice. Here in “intensive support” disability services, in the six months I’ve lived here, I’ve been dragged to my room twice and, while I personally am not locked up in my room or in a seclusion room (as of yet), others here are locked up in their rooms every night. Speaking specifically about physical restraint, it happens multiple times a week here (and I’m not on the strictest unit by far) and no-one cares whether the client is held down by staff of the same gender. The purpose isn’t injecting them with meds as far as I’m aware, but “calming” the client, odd as it seems to me.
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