1 in 4 mental health patients controlled with drugs, restraints
TORONTO - Despite being intended as procedures of last resort, a significant proportion of patients admitted to mental health beds in Ontario are subjected to behavioural control measures such as physical restraints, medications and seclusion, a study has found.
The report by the Canadian Institute for Health Information (CIHI) says one in four patients with mental health issues admitted to a general hospital or psychiatric facility in the province are physically or chemically constrained to prevent them from harming themselves or others.
"We looked at over 120,000 people admitted for mental health services over four years," said co-author Ian Joiner, CIHI's manager of rehabilitation and mental health. "In looking at the data, we found about 30,000 people had experienced some form of control intervention.
"And control intervention is a broad term we use to describe things such as physical restraint, which is holding someone down, (and) mechanical restraint, which is the application of a belt or a strap to either hold down their arms or restrict movement," he explained.
Seclusion involves putting a patient in a room alone for a set period, while medications typically administered are fast-acting antipsychotics, sedatives or tranquillizers.
Almost 60 per cent of the patients -- many of them exhibiting violent behaviour -- were controlled with drugs, while about 20 per cent were held down or mechanically restrained, and another 20 per cent were temporarily put alone in a room, said the report released Tuesday.
Almost 80 per cent of mental health patients in Ontario are admitted to general hospitals, while the remainder are treated in psychiatric hospitals.
Joiner said the researchers found that patients admitted to a general hospital for mental illness were about 1 1/2 times more likely to be constrained in some way than those in a specialized psychiatric hospital.
And patients in general hospitals were more than 2 1/2 times as likely to be held down by staff or have straps around their wrists, waist or ankles than their counterparts at psychiatric facilities.
Violent behaviour was also closely linked with control interventions. "The risk of harm to oneself or someone else was a fairly strong factor in explaining their use," Joiner said from Ottawa.
"More than half of people who received any type of control intervention were posing a threat or danger to themselves," he said. About one-third of those constrained were seen as a threat to staff, family members or other patients.
The report also found patients who had difficulties making themselves understood were more than twice as likely to be restrained somehow than those without such difficulties, while those who were incapable of consenting to treatment were almost 40 per cent more likely to be restricted.
Even though patients who experienced control interventions were almost twice as likely to have engaged in recent violent behaviour, the report noted that 71 per cent had not been aggressive toward others.
"Although some patients who experience a control intervention exhibit violent behaviour, most do not," Dr. Nawaf Madi, program lead for mental health and addictions at CIHI, said in a release. "An inability to communicate or to make decisions can result in confusion, both for the patient and the provider, and limit the effectiveness of more moderate approaches.
"Understanding such risk factors can help defuse a potentially difficult situation before it is aggravated."
Debra Churchill, director of professional practice for the 329-bed Ontario Shores Centre for Mental Health Sciences in Whitby, Ont., northeast of Toronto, called the report "very powerful ... because it bears witness to what's happening in mental health care."
Professional guidelines and provincial regulations caution health providers to use behaviour-control measures on patients only as a last resort. In Ontario, for instance, restraints can't be used on a patient without a family's permission or a physician's order in an emergency.
Churchill said the report raises awareness and should spur care providers working with mental health patients to examine their own facility's practices and come up with approaches other than constraining patients.
"There are lots of organizations out there now seriously looking at what are the other treatment options and how do we approach this," she said. "And the approach needs to be in good assessment, understanding the triggers, training our staff ... in de-escalation and monitoring for this type of behaviour, so the focus is on prevention rather than reacting to behaviour."