Commission bans use of mechanical restraints on children in mental health centres

Mental Health Commission says practice of restraint is not therapeutic and has potential to cause serious harm

The Mental Health Commission has banned the use of mechanical restraints, such as leg or arm cuffs, on children in mental health centres.

The ban comes into force from next January 1st, along with other revisions of the rules for seclusion, mechanical restraint and physical restraint in centres.

The changes include a new code of practice on physical restraint, and a requirement on public and private services to publish information about their efforts to reduce and, where possible, eliminate the use of restrictive practices.

The commission says there has been a substantial reduction in episodes of restraint and seclusion since 2020, but the new rules and code of practice are needed to bring about further improvements and ensure these practices are used only in exceptional circumstances. The rules were last revised in 2010.

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“It is clear from the evidence and from the people who took part in our review that restrictive practices are not therapeutic and, indeed, have the potential to cause very serious physical and psychological harm,” said the director of regulation for the commission, Gary Kiernan.

“As well as physical injuries, the use of these interventions may increase the risk of trauma and trigger symptoms associated with previous experiences of trauma. Therefore, they must be used only in rare and exceptional circumstances as an emergency measure to keep the person or those around them safe.”

The commission says only one centre, the Central Mental Hospital, reported the use of mechanical restraint in 2021, with 25 episodes. These varied in length from 17 minutes to four hours.

The total duration mechanical restraint was used fell massively, from 3,452 hours in 2020 to 49 hours in 2021.

Last year, there were 4,636 episodes of seclusion and physical restraint, involving 1,790 residents, recorded in 67 inpatient mental health centres. This compared with 6,747 episodes involving 1,803 residents in 2019.

There were 3,460 episodes of physical restraint last year, down from 5,029 in 2019.

A total of 1,176 episodes of seclusion were reported by centres in 2021, a decrease from the 1,840 episodes reported in 2020.

Mechanical restraint refers to the use of devices or garments for the purpose of limiting the free movement of the body. Physical restraint is the use of force by one or more people to prevent another’s free movement, when that person poses an immediate threat to him/herself or others.

Commission chief executive John Farrelly said although restrictive practices may, on occasion, be necessary to maintain safety in the day-to-day environment of an acute mental health service, it still expected to see reductions in the use of these practices from 2023.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times