The trouble with chemical restraint

Chemical restraint to control consumer behaviour and manage risk of harm, is prevalent and controversial. It has been described as highly coercive, and has negative emotional and physical effects on consumers. There is a pressing need to synthesize and evaluate research regarding prevalence, reasons for administration, and characteristics of consumers who are restrained in this way. In Australia, there is impetus for the elimination and reduction of all forms of restraint with consumers with mental health problems, led by groups including the National Mental Health Commission and supported by the ACMHN. Chemical restraint is not easily defined, and attempts to do so have revealed that contexts of care, Emergency Departments, psychiatric inpatient units and medical conditions, drug and alcohol intoxication and psychosis are highly influential in determining the nature and use of chemical restraint. The trouble with chemical restraint is that as a concept, a key issue is whether the restraint is part of treatment per se or management of a patient's condition or behaviour. In a quantitative study of the incidence of the use of chemical restraint in Adelaide, South Australia, data were collected over a one‐year period on 12 adult acute inpatient psychiatric wards. Documented variables included demographic characteristics of consumers and characteristics of events, including time of event, types of medications used, other intervention strategies, and documented severity levels of events. There were 166 chemical restraint events involving 110 consumers. Out of 12 acute inpatient psychiatric wards, approximately 77.1% of chemical restraint events occurred on two closed wards. The highest prevalence rate in an individual ward was 28.78 chemical restraint events per 1,000 occupied bed days, compared to the lowest rate being 0.12 events per 1,000 occupied bed days. More males (n = 69, 57.5%) were involved in chemical restraint than females. Very few events reported the use of de‐escalation skills in documentation. These findings report on chemical restraint incidence for the first time and will be discussed within the context of barriers to reducing restraint in clinical practice and aid to inform recommendations for practice change and future directions.