TORONTO - Advocates for the mentally ill are calling for provincewide regulations on the use of restraints as a coroner's inquest continues into the death of a patient who died after being bound by the wrists and ankles to a bed for five days.

Jeffrey James, 33, died on July 13, 2005, after being physically restrained by staff at Toronto's Centre for Addiction and Mental Health.

Ryan Fritsch, a lawyer for the Psychiatric Patient Advocate Office, said outside the inquest Tuesday that each institution sets its own restraint guidelines.

Instead of that patchwork approach, Ontario should develop provincewide policies requiring each facility to regularly report incidents, he said.

"The (Centre for Addiction and Mental Health) might wind up with a wonderful policy, but what about the other eight mental health institutions in Ontario?" Fritsch said.

"We're worried about that."

In addition to mental health facilities, Fritsch said restraints are also used in some educational institutions and long-term care homes.

"There needs to be central oversight, provincial oversight, for a restraint policy that would apply across the province," he said.

The inquest heard Tuesday that James was a violent, aggressive patient with a tendency for sexually inappropriate behaviour.

James was restrained at the Toronto facility after he was seen performing a sexual act near the nurses' station. A struggle ensued when staff tried to stop him.

James spent five days in the four restraints -- one for each wrist and ankle. When he was released, James collapsed and died, likely because of blood clots travelling to his lungs.

Since James's death, the Centre for Addiction and Mental Health facility has been examining its policies for using physical restraints, "trying to look for any way we can reduce or maybe get rid of them altogether," said Howard Barbaree, a psychologist with the facility.

Still, Barbaree said there is debate among staff about the use of restraints.

"I think there is still a complement within the staff ... who feel (it's) the only thing that can be done to prevent a violent incident and protect the staff," he said.

When a patient is agitated or aggressive and staff turn to restraints, it's not a decision that's made lightly, Barbaree said. The situation -- known at the institution as a Code White -- is often "chaotic," and staff would describe it as "frightening," he said.

Over the past three years, staff have reduced the use of restraints by 67 per cent, Barbaree said. So far this year, there has been only one incident where a client had to be restrained, he told the inquest.

On Monday, lawyers for the facility suggested that James's size -- he weighed 267 pounds -- might have contributed to his death, though Ontario chief pathologist Michael Pollanen rejected that notion. He attributed the death to blood clots that had moved from veins in James's thighs into his lungs.

Inquest lawyer Michael Blain confirmed Tuesday that James had a mental illness that caused him to think that a "world army" would harm him and his relatives if he didn't seek sexual favours.

At one point, James was arrested for sexual assault but was found not criminally responsible due to mental illness. He was also accused of assaulting a police officer upon his transfer to the Centre for Addiction and Mental Health.

The inquest runs through Oct. 3.