Restrictive and Defensive Practices in Mental Health: Alternate Strategies for Violence Containment

This report discusses the harmful effects of restrictive and defensive practices in mental health and proposes alternate management strategies for the containment of aggression in impatient psychiatric settings. It also highlights the adverse effects of psychological, social, and physical final outcomes which show a higher level of risk related to death chances. The report concludes with strategies such as leadership, using data, preventive measures, workforce development, and debriefing to reduce the practices of restraint and defensive in patient settings.

ASSESSMENT 3 ESSAY

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Essay over restrictive and defensive practices in mental health along with proposing alternate
strategies for the system of violence...........................................................................................1
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Mental health learning is a skilled profession well positioned in a manner to provide
support to diversified patients towards recovery with the help of evidence based therapeutic
interventions (Perry, Banon & Bond, 2020). No doubt just like any other profession, this also
continues to be challenged by tensions surrounding the delivery of restrictive intervention and
having related concerns as well. Within the current report, the restrictive and defensive practices
in mental health will be discussed along with provide recommendations over alternate
management strategies for the containment of aggression in impatient psychiatric settings.
MAIN BODY
Essay over restrictive and defensive practices in mental health along with proposing alternate
strategies for the system of violence
Restrictive practices into mental health consists of seclusion within which patient is
confined alone into a room or an area from which the free exit is prevented or even restraint. It
could be physical or mechanical in nature. The physical restraint involves hands-on
immobilization techniques performed by health acre staff member and mechanical includes the
usage of devices just like straps and belts in order to make the patient restrict to do tasks.
Moreover, in context of defensive practices it has been perceived as widespread into psychiatric
setting which includes asking questions to patient about their safety, admissions within the
hospital as well as delayed discharge from hospital premises (Barragán-Medero & Pérez-Jorge,
2020). This often perceived as occurring for fulfilling the purpose of defensive practices. From
various researches, it has been identified that restrictive practices are often harmful in nature and
most of the clinicians and health care professionals do agrees that this activity should be reduced
into the care settings. The restrictive or defensive practices and their interventions are often
utilized interchangeably irrespective of their different meanings.
It is basically a concept of making someone does something the individual do not want to
perform and on the other hand, stopping them from doing things they want to perform. People
who are suffering from mental illness, their care providers advocates that restrictive and
defensive practices are never provided any kind of benefits to any of the patient and thus, such
kind of interventions always or often infringe over human rights along with compromise with
the therapeutic relationship among patient and health care professional. Even the Australian
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health minister's also tries their best to remove such kind of practices from consideration. Each
and every state and territories have different legislations over the treatment of people with
mental illness as all have specific provisions related to the treatment of people into an
involuntary capacity (Fox & Picciotto, 2019). This illustrates that under some specific
circumstances the treatment of mental illness. This highlights that under some of the specific
circumstances the treatment provided to the mentally ill people include medication and
therapeutic interventions that has been provided under a treatment order without the consent of
the people in the hospital, residential area or even at the community.
Apart from this, it has also been evaluated that restrained patients are at high level of risk
for the functional decline which also propose serious injuries or even sometimes death from falls
or strangulation, heart stress, poor blood circulation, muscle weaknesses, infections, skin
breakdown, reduced appetite, social isolation, depression, etc. Moreover, it has also been further
analysed that the mental health care faces certain issues related to the clinician shortages, limited
mental health access parity, fragmented mental health care access and social stigma along with
limited level of mental health awareness among members put them into the conditions within
which the restricted and defensive practices needs to be considered (Zuazo, 2022). The
limitation in order to utilize the restrictive model of care into consideration, which enhances the
older people autonomy and respect the rights of the person, generate individual worth, dignity as
well as privacy level. The death from strangulation is the most serious risk that is being incurred
into the whole concept. Restraint practices never gets utilized for providing punishment,
coercive, discipline and staff convenience. Improper restraints utilized by the professionals can
lead to serious endorsement by the state health department of Australia. Moreover, the physical
way of using restraint or defensive practices have provided certain clinical consequences such as
legal, ethical and clinical.
This exercise basically violate the right of the individual in context of freedom and
dignity. There are numerous evidences available which highlights the adverse effects of
psychological, social and physical final outcomes which shows the higher level of risk related
top death chances (Grimshaw & Ford, 2018). Although, in certain conditions or situations, such
practices are required to be involved within the system but with certain limitations which
involves the deliberate application of pain which illustrate that this practice should be utilized in
the extreme conditions when it is extremely required in order to treat any patient. Moreover, it
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must be used and represent the least restrictive option in order to meet the immediate
requirements only. Staff members are recommended to must not use the seclusion other than for
people who are detained under the Mental Health Act 1983 (Cheung, 2021). The practices
related to defensive or restrictive care put the patients and staff members both at high level of
risk in context of death and injury. However, restraints can be traumatic as well even when they
do not resulting into any kind of injury or death condition. Thus, before using the restraint
practices for the betterment of any patient, it is highly recommended to the nurses and other
health care staff members to never use restraints without the consent of patient and except this
only any emergency condition when the patient have a serious threat to any individual or others.
This specific guideline has been outlined in the Patient Restraints Minimization Act, 2001 as
well as also in the consent practice guideline. Moreover, the senior registered nurses giving their
duties, medical practitioners and an authorized psychiatrist must have to immediately release the
person from the restrictive interventions as early as the grounds to the usage of such practices no
more applied into the same. Furthermore, the high level of clinical care, reporting and
monitoring are required at the time of involving restrictive interventions.
In order to illustrate over them, it has been identified that it is a serious issue that requires
to be considered on utmost priority manner. Violence towards the staff members affects their
mental as well as physical health status and can resulted into the absenteeism, stress and
sometimes even resignations. Thus, the primary aim of preventing violence in psychiatric
impatient care aim towards creating a kind of atmosphere that minimizes the risk of violence.
The violence and aggression basically includes the combination of certain elements such as an
expression of energy that may be goal directed and inappropriate behaviour. It is no doubt a
serious issue which affecting the nurses those are working within the psychiatric nursing care
centres. From various researches, it has been identified that verbal and physical violence both by
patients have varied effects over the well-being of the health care providers and especially the
nurses (Neal, Lienert, Denne & Singh, 2022). The most and specified effect of violent behaviour
refers to debilitating psychological consequences for the nursing staff, provide negative
economic consequence, increase the level of staff turnover rates, provide physical harm and
injury, etc. there are various strategies and techniques incurred which have the power to manage
patient aggression in this specific setting. The technique involves the seclusion, chemical
restraints and de-escalation tools. Although the seclusion and use of chemical restraints are not
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known for evidence based intervention but useful in order to manage patient aggression.
Furthermore, it also includes the strategy which is related to providing education and training to
the nurses in order to prevent aggression which is as opposed to control has been provided
appropriate results and has taken the central part into academic solution to resolve issues related
to aggression and violence by psychiatric patients.
Furthermore, another strategy illustrates that one should always identify the cause of
aggression which might become a combination of intrinsic as well as external factors which
includes patient personality, physical symptoms or even their intense mental distress, attitude,
behaviour, physical environment, mental distress, etc. Apart from this, the health care centres
must includes the preventive measure which includes requirement of good leadership which is
highly able to set priorities, validate and compliment great practices as well as challenge to poor
practices. With the help of great level of communication the relationship enhances with the
patient and thus help in order to defuse distress (Hadzic, Carlson & Tavits, 2020). At the time of
generating more complex situations, it needs to be de-escalate. This is the most one of the
behavioural strategy but somehow it is not clear about their role. The urgent requirement of
attending critical situations needs to be addressed in order to make the patient distressed.
In order to act for de-escalation, the medication is the solution which helps into the
whole procedure. The drugs should be targeted as per the symptoms. Management of crisis
should be taken place into appropriate manner. Moreover, on rare occasions when any patient is
unable to de-escalated or chemically restrained then in such cases, the violent patient might
require physical restraint but in limited and pre-defined format as per the guidelines. It must be
used until adequate sedation and should be used as the last resort and in temporary manner
which should be removed as quickly as possible. At the time of applying restraints practices, a
well-educated and trained team must be presented and must require adequate team members for
the patient (Rahman & Simonson, 2020). Under some drastic cases within which the patients
represented their condition as out of control and pose a close danger to themselves along with
the staff members. In such cases, the patient needs to be deeply sedated.
The practitioners are required to protect themselves as the patient and other staff
members initially requires becoming de-escalate the patient. It is because a cooperative patient is
highly required in order to provide them effectual treatment. In general, the care providers have
to remain calm and compose along with listen to their patients in most significant manner. This
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reduces the treat of originating the threat among the users who are available at the premises or
even provide services to their patients. Apart from this, with the help of providing appropriate
respectful personal space while maintaining a safe position, establishing verbal contacts, be
precise, listen closely and identify their requirements in most successful manner have the
capability to avoid such drastic conditions which originates the feeling of aggression and
violence among the patients as well as the care givers (Hsin & Aptekar, 2022). And even when
the condition arises, the nurses or care providers have to taken care of certain specific things
which includes taking care of body language, create good eye contact move slowly and steadily
along with respecting their personal space makes them calm in order to handle the adverse
situations.
From various studies, de-escalation is the primary approach that is being used in order to
manage the violent patients in the emergency department. This requires setting of limits which is
the key to the de-escalation such as when a person is progresses through the crisis situation, the
staff members needs to provide them respect, and sets out reasonable and simple limits for them
(Holliday, Rozek, Smith, McGarity, Jankovsky & Monteith, 2019). They should have to offer
them respectful choices and consequences, as the person is unable to focus towards the guidance
that has been provided to them because of their mental health status.
CONCLUSION
From the above report it has been concluded that With the help of implementing certain
strategies such as focusing towards the leadership, using data in order to inform practices, by
proper involvement of youth as well as families, using appropriate preventive measures and
tools, workforce development and debriefing, the staff members are able to reduce the practices
like restraint and defensive into patient are settings. As per the policy that are the least restraint
indicates that other interventions are considered and implemented in order to address the
behaviour which is highly interfering with client safety.
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REFERENCES
Books and Journals
Barragán-Medero, F., & Pérez-Jorge, D. (2020). Combating homophobia, lesbophobia, biphobia
and transphobia: A liberating and subversive educational alternative for
desires. Heliyon, 6(10), e05225.
Cheung, C. (2021). Abolition pedagogy is necessary. Journal of higher education in prison, 1(1),
50-68.
Fox, J., & Picciotto, G. (2019). The mediating effects of spiritual bypass on depression, anxiety,
and stress. Counseling and Values, 64(2), 227-245.
Grimshaw, R., & Ford, M. (2018). Young people, violence and knives: Revisiting the evidence
and policy discussions. Centre for Crime and Justice Studies, 3, 1-29.
Hadzic, D., Carlson, D., & Tavits, M. (2020). How exposure to violence affects ethnic
voting. British journal of political science, 50(1), 345-362.
Holliday, R., Rozek, D. C., Smith, N. B., McGarity, S., Jankovsky, M., & Monteith, L. L.
(2019). Safety planning to prevent suicidal self-directed violence among veterans with
posttraumatic stress disorder: Clinical considerations. Professional Psychology:
Research and Practice, 50(4), 215.
Hsin, A., & Aptekar, S. (2022). The violence of asylum: The case of undocumented Chinese
migration to the United States. Social Forces, 100(3), 1195-1217.
Neal, T., Lienert, P., Denne, E., & Singh, J. P. (2022). A general model of cognitive bias in
human judgment and systematic review specific to forensic mental health. Law and
human behavior, 46(2), 99.
Perry, J. C., Banon, E., & Bond, M. (2020). Change in defense mechanisms and depression in a
pilot study of antidepressive medications plus 20 sessions of psychotherapy for
recurrent major depression. The Journal of nervous and mental disease, 208(4), 261-
268.
Rahman, K. S., & Simonson, J. (2020). The Institutional Design of Community Control. Calif.
L. Rev., 108, 679.
Zuazo, S. S. (2022). An examination of three emerging interventions and proposed best practices
to treat Latina women who have experienced intimate partner violence (Doctoral
dissertation, Alliant International University).
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