Sedatives and Restrictive Behavior | Coercive Mental Health Practices

Running head: COERCIVE MENTAL HEALTH PRACTICES
Sedatives and restrictive behavior
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COERCIVE MENTAL HEALTH PRACTICES1
Introduction
People with mental health disorders exhibiting aggressive and violent behavioral symptoms
are often susceptible to self-harm and a threat to the ones around them as well. Due to this
reason, they are dealt with restrictive and coercive management practices and administered
sedatives to control their agitation. Sedatives calm the patients down by suppressing the
functioning of the brain. They directly target the central nervous system (CNS) of the
individual and is known to cause a multitude of side-effects at high doses (Brohan & Goudra,
2017). Besides, it is also known that continued use of these medications make the person
addicted to the drug and reduce their functional capacity without adequate doses. Also, the
dose of medication required for the desired effect increases with prolonged usage.
Nonetheless, these psychotropic medications, the sedatives are integral elements of the
mental health treatment and are frequently necessary for the recovery process. This
combination of pros and cons regarding the use of sedatives has been a debatable question in
mental health practices. Muir-Cochrane & Gerace (2017) state that the use of sedatives and
other psychotropic medications to control the behavioral symptoms of mental health patients
is controversial as it is regarded as coercive accompanied by various adverse effects. This
essay critically discusses the application of sedative psychotropic medications in controlling
behaviors of mental health patients, the use of restrictive and coercive practices, its impact
and the various challenges faced by registered nurses delivering mental health care and
sedatives to the patients susceptible to self and communal harm.
Controversy regarding psychotropic medications
The most common form of coercion used in mental health services is physical restraint, and
the less extensive method is seclusion. All forms of restraint dominate the psychiatric field as
a medical dimension and include acute sedation as the immediate response (McKeown et al.,

COERCIVE MENTAL HEALTH PRACTICES2
2019). There has been a global argument for ending mental health practices that rely on
coercion and force, and replace decision making with practices that are more focused on the
will, interpretation and preferences of the patients. This is also stated in the Convention on
the Rights of Persons with Disabilities (CRPD) under WHO. Nevertheless, it is specifically
challenging to substitute coercive and restrictive practices in mental health and is necessary
for protecting people from harm, and are assertively regulated and sanctioned in legal policies
across all countries. This is followed despite evidence that restraint and seclusion often lead
to the ultimate death of the patient in some cases (Funk & Drew, 2019).
The clinical impact of coercion and sedative administration is serious and can be observed as
impaired behavior in the community, social fear and exclusion, attention disorders and
unreactive mood. A Convention by the WHO questions the acceptability and quality of
coercive mental health care. It also provides evidence that coercive practices in treatment
may result in substantial trauma. Also, it is observed that the fear of coercion and restraint
can even deter help-seeking attitudes (Sugiura et al., 2020). It is also observed that extended
administration of sedatives such as benzodiazepines further deepens the underlying issues
such as anxiety and depression. Other most commonly observed ill-effects of sedatives such
as benzodiazepines and lorazepam include low respiratory capacity, slurred speech,
imbalanced gait and myocardial conditions (Maslej et al., 2017). Prolonged doses of these
psychotropic medications also increase the dependence of the person on these drugs and the
absence of which makes them unsteady and lose functional capacity. The physical impacts of
involuntary practices and sedation include suppressed reflex actions, balance disorders and
often nystagmus. These ill-effects of psychotropic medications to control behaviors
particularly when it is unconsented forms the argument of the controversy. The potential
benefits to the use of sedative psychotropic medications in immediate control of adverse

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behavioral symptoms and the restraint and coercion involved in mental health practices along
with the sever side-effects lead to the debatable subject of their use.
There is considerable evidence supporting the ill-effects associated with restraint and
coercion on the patient. However, Szmukler (2019) debates that in some cases, the use of
involuntary practices such as restraint becomes necessary to promote communal and the
affected person’s autonomy. He also argues that the functional capacity of the brain and the
decision making ability of the affected person is an important determinant in deciding if
forced admission and treatment of the patient is a legitimate response. Moreover, as per the
NICE guidelines, mental health patients and their carers possess the right to make informed
decisions about their approach of treatment but if they lack the required ability to make
decisions, the policies of the Mental Capacity Act 2005 are followed (Nice.org.uk, 2020). It
is believed that the adverse symptoms and effects associated with using sedatives gradually
reduce as the patient gets actively involved in the community.
In contrast to Szmukler’s argument, the decision making impairment of a person is
subjective. For example, refusing a blind person to drive can be considered as an action
requiring restraint. It is objective that a blind person cannot be allowed to drive. This act of
denying a blind person to drive is not the same as denying a person, with decision-making
impairment, their right to make their own decisions regarding admission and treatment. The
determination of the decision-making ability of a person is completely subjective and cannot
be concluded by the health professional as decision making depends on individual
perceptions, which themselves are considered subjective. In this example, it is important to
understand that the blind person is not necessarily interested in the act of driving, instead his
fundamental interest is the freedom of movement that driving offers. Similarly, in cases
where the decision-making capacity of the person gets affected, the obligation must be to
hold them up in making their own decisions on an equal bias. This assistance may be in the