Physical restraint, mental health, trauma + women

[BBCNewsRave]

Don't know what to say... not sure how reliable this is... but...

From the Guardian:

Our research showed that one in five women and girls were physically restrained in mental health settings and that the use of face-down restraint continues to be widespread
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In some trusts, restraint against women and girls was commonplace, with three-quarters being physically restrained, and up to a third restrained face-down.
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There were nearly 2,300 incidents of face-down restraint against girls, compared with fewer than 300 against boys. There were also 4,000 incidents of face-down restraint against women, which was more than that of men – despite women being a smaller proportion of patients.
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Being physically held down and having your clothes pulled out of place, often in front of others, can be an extremely humiliating, as well as frightening, experience. Not only that, but restraint is often carried out by male nurses, another factor that compounds the fear and trauma of those women and girls who have histories of abuse and violence at the hands of men.

The disproportionate use of restraint against women seems particularly concerning. I suppose we don't know the actual difference, but you'd expect it to be way higher for men, given the general level of violence in the population.

I'd also like to point out that physical restraint means every nurse on the ward piles in. And that mental health wards tend to sort you by your postcode, not your illness. So you get violent people in with people who have panic attacks and anxiety.
Before sex segregated wards were introduced, rapes were frighteningly common, at least 3 a year. Thats in a situation that is supposed to be supervised round the clock.

That research is really worrying.

The use of C&R has always been contraversial, and I tended to do absolutely everything in order to prevent it, but there are instances where there is little else that you can do in order to prevent harm to the person being restrained and/or others.

We had to justify every single instance of C&R, and I have known more than one HCP to get into incredible amounts of trouble where they were unable to do so.

I have never heard of a situation where "every nurse on a ward piles in" partly because it's against all training and partly because it would be unjustifyable. I include times when I worked on "locked" wards with people who were there on HO sections in that.

If that is something you have experienced, then it is wrong and needs to be addressed.

It was common while I was in, the nurses each had an alarm. If one alarm was triggered every nurse piled in. The last time I saw that was 5 years ago.

Then you should complain about it, because it's against guidelines. If nothing else, it leaves other patients vulnerable and no one wants to do that.

I'm probably going to hide the thread now, because these threads tend to end up being one long thing about how awful MH care is, and to blame the nursing staff for it. Not because I think nursing staf are blameless, I know some people who shouldn't have been allowed to look after snakes who were senior staff nurses, but because I feel that there should be a safe place where people can let off steam about their experiences without having someone come and try and justify why things happen as they do.

So, not a flounce, more a leaving you a safe space

I wonder if this is another situation of people leaping to that solution because they can.

Physically restraining a woman may seem the easier choice than doing something else, unlike for a man, where physically restraining would be harder thing to do, so alternatives are looked for?

I have no experience of mental health care settings, so I'm just comparing to other situations where you could choose a persuasive, or a physical solution - eg, trivially, giving a child medicine, and whilst you'd likely restrain a toddler, you'd persuade an older child in preference, because it's much harder to restrain the older child, whereas it's perfectly possible to hold a toddler.

I find this really upsetting and don't have anything to add, except a friend of mine had been sectioned and her burning memory of the whole experience was being restrained and saying "they took my clothes off me" - she couldn't process or fathom why they did that. it was so traumatic and humiliating

ChocChoc I think you might be on to something there. It is generally easier to physically restrain a woman; so perhaps staff have a (hopefully unconscious) lower threshold for using restraint as a technique to manage women compared to men where they may make more effort to avoid restraint as it is a physically more daunting/difficult task?

Xenophile - this is on FWR rather than the mental health forum and as a woman and MH patient I would appreciate your inside knowledge. I find the explanations reassuring. My question is - is this issue (the sex bias, rather than use of restraint itself) something that is a concern within the profession, and are there any voices suggesting how it could be addressed?

This doesn't surprise me. I've had 2 hospital admissions and the first time when on section on an adolescent ward I was restrained face down so many times. Given my history of childhood trauma I found this very distressing. It was also not usual to feel them tugging at your trousers
To give you an injection of some kind of antipsychotic into your arse. Horrendous given my history. The staff in the wards used to use restraint as a threat and were know to say if you do not do x we will get men to come and hold you down.

It was awful and really traumatising

Physical restraint is always a last resort after verbal de-escalation. I've nursed both men and women in a secure hospital. These are my experiences and I can't claim to say they're representative because I've only worked one place.

Men (generally) get restrained for violence and aggression. There is very little significant self harm in our male inpatient population. Some of this is due to psychosis, which there is medication that can be administered which generally helps - less psychosis = less assault = less restraint.

Women (generally) get restrained to prevent them significantly hurting/killing themselves. I'm not talking for minor cutting/head banging, I'm talking serious self mutilation and ligature tying. Most of the women I work with are not psychotic, and medication does not easily take away the urge to self harm. What usually happens is we see someone doing something potentially deadly, attempt verbal de-escalation if it is safe to do so, then escalate to physical restraint, (arm holds are always attempted first) at which point women tend to fight us to prevent us intervening. Of course, we also have women who are violent and aggressive towards staff, but even then, we don't intervene physically for verbal threats or abuse, only physical assaults or attempted assaults. The 'removing the clothes' is only done if we suspect a person is going to use their clothing to hurt themselves (usually because they have already been doing so) with and they won't change into 'strong' (i.e. unrippable) clothing voluntarily. They are not left naked and we only have female staff present when this happens.

Women try to hurt/kill themselves much, much more frequently than men try to assault people at my hospital. If 'everyone piles on' is your experience then I do recommend you complain, because although there can be a certain amount of tussling when taking someone to the floor, after they are on the floor (face up is the policy in my trust, and every episode of face down restraint is investigated) there will be one person on each arm, one managing the head, and possibly up to 2/3 on the legs depending on the persons size and strength. There should never be anyone on the torso.

As I say, this is my experience. And I agree, there are occasionally people who are a bit quick to rush to physical restraint, but we do quite well at weeding them out and getting rid. Every time we use restraint we put ourselves and the patient at risk of harm, and from a purely selfish point of view I can't afford to take time off with a work related injury! Most people see it as an unpleasant but sometimes necessary part of their job.

And I too may not be back, I've also seen how these threads go But I hope that helps a bit.

MissSMA
That's really interesting, about the different reasons for restraint and the types of reason men vs women are in hospital. I hadn't thought of that.

I didn't put it in my original post as I thought it wasn't relevant, but I am fascinted by the differences in MH between men and women and why that might be, and what the implications are. One thing that's made me think, and it's only anecdotal obviously, is that there seem to be quite a lot of women around in my position - fairly together, pleasant people (if I do say so myself ) .... but still very much affected by longstanding MH issues, often due to interperonal trauma of some kind, unable to work full time etc (but still uses time constructively where possible). But there doesn't seem to be the male equivalent so much, or rather, the male "equivalent" is a dickhead. He drinks heavily/takes drugs, treats women like shit, is manipulative, violent, can't manage to look after himself in basic ways (cooking, eating properly, housework). He likely doesn't frame his issues as mental health (or even acknowledge his issues unless as manipulation). I suspected it was to do with the different "acceptable" ways of showing/dealing with emotions, and the effect of male vs female socialisation combined with trauma.

I also wonder why men get diagnosed with different things. I wonder if there is bias in diagnosing? Are men taken more seriously? And why would their expression of mental illness be different to women's - socialisation? Are the same root causes causing different "illnesses" down the line, in men and women? Hmm...