Restrictive and Coercive Measures in Mental Health Care

Running Head: Mental Health 1
Restrictive and Coercive Measures in Mental Health Care.
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Mental Health 2
Introduction
Adoption of appropriate measures to manage mentally ill patients by countries is
essential to reduce the burden of the illnesses. A national health mental report showed that
psychiatric disorders might vary from eating disorders which are a mild condition to severe
diseases such as Psychotic disorders such as Schizophrenia (DoHA, 2013). The Mental
Health Services in Australia (MHSA) (2020), has estimated that almost half of the
Australians aged above 16 years may experience at least one mental disorder in their lifetime.
On a global scale, the burden of mental illnesses is on a rising trend (Vos et al., 2017).
Mental disorders are characterized distortion of fundamental thinking, distorted perceptions
and emotional responses (Morgan et al., 2011). Effects of these disorders may make the
patients aggressive and violent, which may hinder the administration of health care.
Therefore, health staff may opt to use coercive or restrictive measures to manage the patients.
These measures have impacts to both the patients and the nurses as discussed in in this paper.
One way through which the staff apply coercive measures is by inducing sleep in the
patients through the use of sedatives (Latha, 2010). The use of restrictive measures gives the
nurses an easy time while applying the treatment procedure. This is because the patients
might present with aggressive and violent behaviour such as kicking and punching that may
cause injury to the parties involved (Parker, 2015). Safe delivery of medication is one
positive impact of coercive measures. According to Roberts, (2019), psychotropics act on the
Central Nervous System (CNS) which helps reduce anxiety and violence behaviour.
Negative impacts of coercive measures may arise from the use of the psychotropics
such as sedatives. According to Ferreira (2017), long term usage of such medications has side
effects, including sexual dysfunction and extrapyramidal effects. Other impacts include
damaging therapeutic relationship and breach of ethical principles (Stephenson et al., 2013).
The use of more appropriate procedures such as the recovery-oriented mental health services

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as outlined by the Australian Health Ministers' Advisory Council (AHMAC) (2013), may be
key to overcoming the negative impacts and controversies surrounding restrictive measures.
Recovery-Oriented Mental Health Service Delivery
In mental health care, recovery is a unique process and personal experience defined
by each mentally-ill patient (Davidson et al., 2008). Recovery-oriented mental health care is
essential in replacing overcoming the negative impacts of coercive measures in mental health
care. According to the Victoria Department of Health (2011), the framework for this
approach encompasses a number of domains that guide mental health specialists. The
approach offers self-determination and autonomy, focuses on the strengths of the patient,
promotes a culture of hope, and holistic, personalized care, among others. Recovery-oriented
mental care leads nurses to make treatment decisions based on a patient's needs, values,
circumstances and resources. The collaborative relationships offered by this approach fosters
the understanding of the client's concerns, goals, needs and preferences, thus challenging
stigma in mental services and the larger community. Recovery-oriented mental health care
also fosters therapeutic relationships between the patient and staff because it reduces the
demarcation that would have otherwise resulted from restrictive measures (AHMAC, 2013).
Waldemar and her colleagues (2016) have shown the need to do more research on recovery-
oriented practice not only in Australia but also in other countries such as the United
Kingdom, Canada, U.S.A and Ireland. The approach is essential in stabilizing patients and
relieving symptoms.
Controversy Surrounding Coercive Measures in Mental Care
There have been calls to eliminate restrictive measures around the globe. Involuntary
hospitalization, according to Hotzy and colleagues (2018), has serious implications to
Switzerland and United States citizens’ liberty as outlined in their laws. As in the
international arena, the controversies regarding coercive measures have also emerged in

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Australia with claims that the measures breach the ethical principles guiding health care. The
rights of patients are governed by the principles such as autonomy which the measures
breaches. Patients are supposed to have a say in the type of treatment they desire. The effects
of psychotropics used are also a source of controversy in mental health care. The use of
sedatives has side effects that can be life-threatening. The side effects include acute dystonia,
sexual dysfunction and myocarditis agranulocytosis (Stroup & Gray, 2018). Luty (2017),
outlines controversial treatments that are widely used in mental health care. Therefore,
overcoming the negative impacts of restrictive measures through recovery-oriented mental
service delivery may be crucial in addressing the controversies.
Impacts of Coercive measures
Restrictive measures are used in mental health care to overcome the non-adherence
that may be shown by some mentally ill patients (Latha, 2019). Coercive measures especially
used include seclusion, restraining patients to beds; and medication that may be administered
forcefully or without the knowledge of the patient. Several national and international studies
have shown the negative and positive impacts of these measures. According to Fiorillo et al.,
(2011), the measures should be sought to as the last option due to their negative effects. The
Department of Health and Ageing in Victoria, Australia, has outlined some of the negative
consequences of coercive measures (DoHA, 2013). Amidst the negative impacts, nurses have
shown their positive attitude toward the use of these measures.
Creation of a safe working environment while attending to psychiatric patients is a
positive impact of restrictive and coercive means. The use of restrictive measures ensures the
safety and comfort of the patients themselves. Nurses in Australia and other countries have
reported that restrictive measures give them an easy time to administer their services. Some
patients might present with violent behaviour that may include abuses which can demoralize
the nurses. Every time coercive measures are used, the nurses are able to protect their own