Mental Health Essay: Restrictive and Coercive Practices Analysis

This essay delves into the critical aspects of mental health, focusing on restrictive and coercive practices within the field. It examines the increasing prevalence of mental health illnesses globally, particularly in Australia, and highlights the influence of social determinants on patient well-being. The essay traces the evolution of mental health treatments, from restraints and electroconvulsive therapy to the use of psychotropic medications, discussing the controversies surrounding their long-term use, side effects, and potential risks, especially in children and youth. It emphasizes the ethical considerations and challenges faced by mental health nurses in administering psychotropic drugs, including medication errors, lack of knowledge, negative attitudes, and the impact of bioethical principles. The essay underscores the importance of recovery-oriented practice, culturally competent care, and the need for critical decision-making skills in addressing complex mental health conditions. The essay also discusses the 'off-label' use of psychotropic drugs and the need to avoid treating children as 'small adults'. The essay also highlights the need for a comprehensive approach to mental health care that prioritizes patient safety and well-being.

Running head: MENTAL HEALTH
MENTAL HEALTH
Name of Student
Name of University
Author note

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It is important to be noted that in the recent era, the number of mental health illnesses
has increased globally and across the country of Australia as well, given the level of stress
and anxiety that has affected the public health at an increased rate (Singer et al., 2019). The
social determinants of health such as lack of employability, lack of income and lack of
socioeconomic stability, non-accessibility to quality health services and primary as well as
institutional health services, lack of knowledge and education in addition to awareness about
one’s own health has led to the various complications with respect to the physical health as
well as with the mental health of the patients in a clinical care scenario (Stübner et al., 2018).
It is to be critically noted that in the community settings as well as in the urban settings, the
number of psychosocial, behavioral and developmental mental health complications are
increasing and it is interesting to note that not only the adults but the children are also
affected deeply and equally by the mental health conditions as much as the adults (Brandt &
Leong, 2017). In the previous century, before the developments in the field of
pharmacological management procedures in the field of psychiatry (Bommersbach et al.,
2016) – mostly the restraints and the electroconvulsive therapies were used to control and
manage the severe mental health conditions where the mental health affected person who has
deep seated depressive, manic, personality, mood, affect and perceptual issues or behavioral
issues and his behaviors are attributed by self-harm or harm to others as well (as seen in the
cases of psychosis and progressive or organic brain degeneration). Gradually, as the
scientific and the medical history suggest, with the evolution of new medications in the field
of medical psychology and psychiatry, medications such as sedatives and psychotropic
medications – the attention and the medical-scientific or rather the evidence based practice
shifted from the use and application of electroconvulsive therapy and the physical restraints,
seclusion to the use and application of psychotropic medications such as antidepressants,
anti-anxiety, hypnotics and the antipsychotics as well. From the later half of the last century,

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the use of psychotropic medications was highly popularized across the world and was
considered as huge development in the field of medical psychology or psychiatry.
Institutionalization versus deinstitutionalization of the mental health patients was huge
controversy and there has always been a debate about the span of stay of the mental health
patients in the nursing homes and in the hospitals as well and after what amount of time (Snir
& Raju, 2019) – the person can be discharged so that there is full recovery and very less
chances of readmission (Chisolm & Payne, 2016). The use of psychotropic drugs when it
started initially, for the first few decades made a very positive change in the society and in the
treatment culture of the mental health patients and it showed effective promise in the
treatment of severe self-harm conditions as well in cases of psychosis as seen dementia,
Alzheimer’s disease and in major depressive symptoms related disorders as well (Finkelhor
& Johnson, 2017). A diverse range of psychotropic medications were designed and they
primarily affected the chemical content and chemical makeup of one’s brain thus affect
mood, affect, behavior and emotions of a person – thus helping the recovery process in
various mental condition conditions (Tait et al., 2016). But as a matter of fact, the adverse
sides of these psychotropic drugs were never researched upon until the late end of the century
and when researched and audited upon the various adverse dug events following the
prescription, administration and intake of psychotropic medications- severe debates opened
up and controversies on whether to use psychotropic drugs to that extent and across all the
age groups especially in the children and in the youths arose. In the last few decades, the
controversies surrounding the use of psychotropic medications to control behaviours and
manage the symptoms for people who experience mental illness have taken a serious rise
(Ellett et al., 2018).
It is to be noted that the common psychotropic medications that are used in the
clinical scenario are alprazolam, Prozac, fluoxetine, Ativan or Lorazepam, Lexapro or

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Escitalopram and these psychotropic medications generally come with a list of side effects
starting from drowsiness to dizziness, to nausea, vomiting, signs of euphoria, hallucination
and also in cases, the severe side effects of using these chemical modulating
neurophysiological psychotropic drugs added included chances of addiction, recreative and
psychosocial addiction and dependence when administered to the youth. According to the
research conducted by Muir-Cochrane & Gerace (2017), it was clearly mentioned that the use
of any restraints – whether chemical or physical is illegal and also very unethical with respect
to the Australian national standards of mental health practice and by the chemical restraint –
the use of antipsychotic drugs were meant. It was found in this scholarly research that about
166 adverse drug event occurred in about 110 mental health patients in two wards and that
the males (55.7%) were more affected by the same than the females. The adverse side of
effects of the psychotropic medications include insomnia, delirium, hypersomnia, sexual
dysfunction and neuro-hormonal disturbances. The use of chemical restraints such as
psychotropic medications was not only life threatening but coercive in nature as well and that
it severely affected the patients both physically as well as mentally. selective serotonin
reuptake inhibitors, the monoamine oxidase, the serotonin- norepinephrine reuptake
inhibitors, tricyclic inhibitors, the benzodiazepines and the other classes of drugs that are
used to modulate the chemical flow and the chemical interaction in the brain thus modulating
the neuropsychology for the patient with mental health disease or condition but when used on
a long term basis or administered wrongs or in wrong doses or in scenario when a
psychotropic drug has a negative drug interaction with another dug – the side effects become
adverse to the point of life threatening as well. It is to be noted that in the serious
circumstances, the use of psychotropic drugs in the children and the youth can lead to the
development and the undertaking of suicidal attempts as reported by various scientific
researches being undertaken in the recent and the last few decades. As reported, the use and

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the application of the selective serotonin reuptake inhibitors for the treatment of the major
depressive episodes and depression related conditions in children is dangerous (Rej et al.,
2017) and the chances of severe risks and rise of controversy is very high as the same drug
that is used the treatment of depressive symptoms in the children has been shown to be
contributing and adding to more depression on a long term use and the researches also
showed when the selective serotonin reuptake inhibitors are administered alone to treat these
conditions, the risk of suicidal attempts in children and also in the young adult population is
actually as high as 9.2 per cent in comparison to a situation when this psychotropic drug is
coupled with cognitive behavioural therapy ( CBT) when the chances of posing suicidal risks,
self-harm behaviours in the middle aged children especially and in the adolescents was found
or rather reported to be around 4.7 per cent (Lakhan & Hagger-Johnson, 2007). It can be
easily observed the use of psychotropic drug might not only prove lethal in different way but
how the controversies about the danger in ‘off label’ use of these anti depressive psychotropic
drug is true. It is important and also very much vital to be noted that the psychotropic drugs
used in the treatment of personality disorder such as bipolar disorder might have the similar
self-harm effect and add to the complicacy of the clinical situation (Collamati et al., 2016).
The various aspects of the problems and the issues around the use of psychotropic drugs in
mental health conditions surrounds around the subject of ‘off label’ use of unapproved
psychotropic drug in the treatment of childhood bipolar disorder or mental health conditions
such as childhood depression. These drugs are not approved by the major drug authorities of
the globe but still used illegally by the doctors and the psychiatrists and also by the clinical
psychologists in addition by the mental health nurses to treat the depressive or emotional or
the personality disorder to the children and it is important to note that the off label use of
psychotropic drugs often means the development of more adverse complications of these
psychotropic drugs in the children and in the adolescent youth than the adult, thus adding to

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negative side of the psychotropic drug use in mental health settings. The unapproved drugs
are not yet tested and might carry more risks those are very serious and serious in nature. As
per the research progresses, new developments have been made regarding the developmental
stages in early, middle and late childhood and the controversy regarding the treating of
children as ‘small adults’ by the use and the application of the psychotropic drugs are taken
into serious consideration and addressed by strong scientific and medical evidences (Sheehan,
2018). The researches has suggested that the children and young adolescents as well as the
old adolescents should not considered as ‘little adults’ and given the same psychotropic
medications as that of adults that can add to the aggression, more severe self-harm and harm
to others behaviours, suicidal attempts and suicidal risks along with more chances of
depression in the children. The scientists have reported the children are a different population
all together and they have different perception, sensitivity to trauma and different coping and
adjusting styles to trauma and there is always a huge chance as the brain is still to develop
and the emotional as well as the cognitive development is still to occur in the children – this
might ‘rewire’ any neuropsychological distortions or derangements that might have occurred.
To practice as a registered nurse in the mental health settings, there are various types
of the challenging aspects in administration of the psychotropic medication to the consumers.
The psychotropic drug administration poses a range of issues and risks that leads to the
developments of the adverse drug events in the promotion of recovery-oriented practice. The
first and the foremost challenge is the disruption at the workplace leading to negative
interactions and lack of peer support and guidance from the senior supervisor nurses that
leads to committing of medication administration errors by the new graduate nurses working
in the mental health settings. Lack of psychological safety in the new graduate nurses is a
huge challenge and so is the lack of knowledge about the action of psychotropic medication
and about the specific mental health condition and the lack of decision making in whether the

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psychotropic drug has to be administered or not in a certain mental health condition or to
particular age group – forms the other nursing challenges with respect to the administration of
psychotropic medications to the consumers. Negative attitudes, social stigmas, lack of
openness, lack of culturally competent practice and the inclusion of self-stigma are the multi -
level and multi-faceted challenges that affects the various nursing practices with respect to
pharmacological management in the mental health settings. The lack of proper clinical
reasoning skills, of the critical decision making skills - in a highly complicated and adverse
mental health condition scenario also forms the challenges to the mental health nursing
practice in relation to the medication administration. The ethical aspects of the bioethical
principles of nursing that includes autonomy, integrity, totality and vital the two critical
principles of beneficence and non- maleficence which are often contraindicated and adversely
affected when a mental health nurse decides to use a psychotropic medication to restrain the
patient’s aggressive, self-harm and harm to others behaviours. It is to be critically noted that
is a very complex area of nursing clinical decision making and safe clinical governance with
respect to the national quality standards pertaining to mental health care being delivered to
the consumers – as the use of psychotropic medications and sedatives can treat a condition or
equally led to a causation of a severe adverse event such as a suicidal attempt or even a
suicide and the choice of psychotropic medication suddenly becomes an ethical and a
punishable act as well. The choice and the clinical decision to be made between the treatment
with physical restraint and seclusion or with the use of the psychotropic medications is
another huge challenge for a mental health nurse and the lack of use of escalation, de-
escalation, documentation, clinical decision making, briefing and debriefing skills and the
lack of collaboration with the other stakeholders in the mental health recovery oriented care
(such as the psychiatrists, the clinical psychologist, the allied health workers, the general
practioners, the patient himself and the family of the patient) poses the severe levels of risks

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and challenges in the medication administration of psychotropic drugs in the recovery
oriented practice.
Hence, it can be concluded saying that the use of psychotropic medications in the
mental health recovery setting is strongly controversial and only under the guidelines of
strong evidence based practice or mental health best practice guidelines – the same group of
drugs should be used in recovery practice settings. It is highly important and also very crucial
that the ethical and legal boundaries regarding the bioethical principles breaching by
application of psychotropic drugs as well the more adverse drug related events caused by
these medications are considered before prescribing and administering the same to
consumers.

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