Psycho-social Restraint in Disability Services Beginning a

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Psycho-social Restraint in Disability Services Beginning a

Transcript Of Psycho-social Restraint in Disability Services Beginning a

Psycho-social Restraint in Disability Services
– Beginning a Discussion
Professor Keith R. McVilly
M.Psych.(Clinical), MAPS, FCClPsy University of Melbourne
[email protected]

Restrictive Practices
Addressed in legislation & policy, in Australia and overseas:
– Chemical Restraint – Mechanical Restraint – Physical Restraint – Seclusion
Australian Commonwealth, State and Territory Disability Ministers, 2014 Department of Health (UK), 2014
National Health Service [NHS], 2017 National Institute for Health and Care Excellence [NICE], 2015

Restrictive Practices
Seeking solutions since the 1700s:
• William Tuke (1732-1822) • John Conolly (1794-1866) • Goffman – The Study of Asylums, 1961

The unstated restrictive practice: Pycho-social Restraint?
• The use of inter-personal interactions, which might reasonably be construed by the person to whom they are directed as intimidating or aversive, and/or threats of social or other sanctions, which rely on eliciting fear to moderate a person’s behaviour
(McVilly, 2009)

Recognising the Reality
• Psychological restraints include those therapeutic regimes or programs which involve the withholding of privileges and participation in activities
(Pennsylvania Code, 2014. 055 Pa. Code § 13.9)

A proposition to consider
• One of the most dangerous restrictive practices in use in disability services
– Insidious – Unrecognised for what it is – Used without regulation, monitoring or review
• Delivered in momentary and transitory doses (PRN) • Its use is not subject to regulation, monitoring, or review • Given ascent and endorsement by by-standers

The use of Psycho-social Restraint
• At best – preventing people to live selfdetermined lives
• At worst – having people live lives of fear and in trauma

The seriousness of Psycho-social Restraint
“… restraint such as verbal control, psychological pressure or social exclusion can be experienced as just as restraining by the individual as physical restraint”.
(Mental Welfare Commission for Scotland, 2006)
Rights, Risks and Limits to Freedom, Principles and Good Practice Guidance for Practitioners Considering Restraint in Residential Care Settings, Mental Welfare Commission for Scotland, Edinburgh.

The seriousness of Psycho-social Restraint
“…‘softer’ methods of limiting freedom such as verbal control, psychological pressure or social exclusion can have just as restraining an effect on a person’s behaviour as direct physical intervention”.
(Mental Welfare Commission for Scotland, 2013)
Practice Guide: Rights, Risks and Limits to Freedom: Edinburgh, Scotland: MWCS.

Recognising the Reality
Restrictive practices Can include:
• constantly telling the person not to do something, or that doing what they want to do is not allowed, or is too dangerous;
• depriving a person of lifestyle choices by, for example, telling them what time to go to bed or get up;
• depriving individuals of equipment or possessions they consider necessary to do what they want to do, for example taking away walking aids, glasses, out-door clothing or keeping the person in night wear with the intention of stopping them from leaving.
(Royal College of Nursing, 2008)
PersonPracticesScotlandFreedomWelfare Commission