–3–
1.7.
Every psychiatric establishment should have a comprehensive, carefully developed policy
on restraint. The involvement and support of both staff and management in elaborating the
policy is essential. Such a policy should be aimed at preventing as far as possible the resort
to means of restraint and should make clear which means of restraint may be used, under
what circumstances they may be applied, the practical means of their application, the
supervision required and the action to be taken once the measure is terminated. The policy
should also contain sections on other important issues such as: staff training; recording;
internal and external reporting mechanisms; debriefing; and complaints procedures.
Further, patients should be provided with relevant information on the establishment’s
restraint policy.
2.
Authorisation
Every resort to means of restraint should always be expressly ordered by a doctor after
an individual assessment, or immediately brought to the attention of a doctor with a view
to seeking his/her approval. To this end, the doctor should examine the patient concerned
as soon as possible. No blanket authorisation should be accepted.
3.
Application of means of restraint
3.1.
Means of restraint should always be applied with skill and care, in order to minimise the risk
of harming or causing pain to the patient and to preserve as far as possible his/her dignity.
Staff should be properly trained before taking part in the practical application of means of
restraint.
3.2.
When recourse is had to physical (manual) restraint, staff should be specially trained
in holding techniques that minimise the risk of injury. Neck holds and techniques that may
obstruct the patients’ airways or inflict pain should be prohibited.
3.3.
For the purpose of mechanical restraint, only equipment designed to limit harmful effects
(preferably, padded cloth straps) should be used in order to minimise the risk of the patient
sustaining injury and/or suffering pain. Handcuffs or chains should never be used to
immobilise a patient. Patients under restraint should always be face up with the arms
positioned down. Straps must not be too tight and should be applied in a manner that allows
for the maximum safe movement of the arms and legs. The vital functions of the patient,
such as respiration and the ability to communicate, must not be hampered. Patients under
restraint should be properly dressed and, as far as possible, be enabled to eat and drink
autonomously and to comply with the needs of nature in a sanitary facility.
3.4.
The use of net (or cage) beds should be prohibited under all circumstances.
3.5.
Patients should not be subjected to mechanical restraint in view of other patients (unless the
patient explicitly expresses a wish to remain in the company of a certain fellow patient);
visits by other patients should only take place with the express consent of the restrained
patient.
3.6.
Staff should not be assisted by other patients when applying means of restraint to a patient.
3.7.
If recourse is had to chemical restraint, only approved, well-established and short-acting
drugs should be used. The side-effects that medication may have on a particular patient
need to be constantly borne in mind, particularly when medication is used in combination
with mechanical restraint or seclusion.
3.8.
As regards seclusion, the room in which patients are placed should be specially designed
for that specific purpose. In particular, it should ensure the safety of the patient and provide
a calming environment for the patient concerned.