–4–
4.
Duration
4.1.
The duration of the use of means of mechanical restraint and seclusion should be for the
shortest possible time (usually minutes rather than hours), and should always be
terminated when the underlying reasons for their use have ceased. Applying mechanical
restraint for days on end cannot have any justification and could, in the CPT’s view, amount
to ill-treatment.
4.2.
If, exceptionally, for compelling reasons, recourse is had to mechanical restraint or
seclusion of a patient for more than a period of hours, the measure should be reviewed by
a doctor at short intervals. Consideration should also be given in such cases and where
there is repetitive use of means of restraint to the involvement of a second doctor and the
transfer of the patient concerned to a more specialised psychiatric establishment.
5.
Selection of type(s) of restraint
In cases where the use of restraint is considered, preference should be given to the least
restrictive and least dangerous restraint measure. When choosing among available restraint
measures, factors such as the patient’s opinion (including any preferences expressed
in advance) and previous experience should as far as possible be taken into account.
6.
Concurrent use of different types of restraint
Sometimes seclusion, mechanical or physical restraint may be combined with chemical
restraint. Such a practice may only be justified if it is likely to reduce the duration of the
application of restraint or if it is deemed necessary to prevent serious harm to the patient or
others.
7.
Supervision
Every patient who is subjected to mechanical restraint or seclusion should be subjected
to continuous supervision. In the case of mechanical restraint, a qualified member of staff
should be permanently present in the room in order to maintain a therapeutic alliance
with the patient and provide him/her with assistance. If patients are held in seclusion,
the staff member may be outside the patient's room (or in an adjacent room with
a connecting window), provided that the patient can fully see the staff member and the
latter can continuously observe and hear the patient. Clearly, video surveillance cannot
replace continuous staff presence.
8.
Debriefing
Once the means of restraint have been removed, it is essential that a debriefing of the
patient take place, to explain the reasons for the restraint, reduce the psychological trauma
of the experience and restore the doctor-patient relationship. This also provides
an opportunity for the patient, together with staff, to find alternative means to maintain
control over him/herself, thereby possibly preventing future eruptions of violence and
subsequent restraint.
9.
Use of means of restraint at the patient’s own request
Patients may sometimes ask to be subjected to means of restraint. In most cases, such
requests for “care” suggest that the patients’ needs are not being met and that other
therapeutic measures should be explored. If a patient is nevertheless subjected to any form
of restraint at his/her own request, the restraint measure should be terminated as soon as
the patient asks to be released.