Few years ago a Senior Citizen was hospitalized for 3 weeks. Post her discharge from the hospital she developed “fear of people” and she stopped allowing anyone to care for her.
Her daughter who resides in another continent rushed back to India to be by her side. For a while no one could figure out the reason for the change in her mother’s behaviour but eventually the problem was identified.
During her mother’s stay in the hospital, her hands used to be tied so that she does not self harm her frail body however no one imagined that this act would leave a scar in her memory.
On closer inspection the daughter saw dark patches on her mother’s hands where the restraining straps were tied. This act of restraint had a deep impact about fear of being harmed due to which she started feeling threatened by the care staff.
Though it is a difficult decision for clinicians to restrain a person for their own safety but unfortunately these type of cases still happen.
India is seeing rapid growth in elderly care & it is important that all stakeholders should be aware of national policies on this sensitive subject.
Mental Health Care Act, 2017 talks about restrictive practices but it’s interpretation on ground level can be debatable.
As per Department of Health and Aged Care (Australia), a restrictive practice is any action that restricts the rights or freedom of movement of a care recipient. Restrictive practices in aged care should only ever be used as a last resort, for the shortest time possible and in the least restrictive form.
There are strict requirements for the use of restrictive practices in most countries however in India we still have a lot of catching up for standardization of Senior Care.
Resource guide “Restrictive Practice use in residential Aged Care”, highlights that there are 5 types of restrictive practices:
- Chemical restraint
- Environmental restraint
- Mechanical restraint
- Physical restraint
- Seclusion
A study on “Patients’ and staff members’ experiences of restrictive practices in acute mental health in-patient settings” highlighted that, recent guidance has called for the reduction of restrictive practice use owing to growing concerns over the harmful physical and psychological effects for both patients and staff.
Despite concerns & efforts, these measures continue to be used regularly to manage challenging behaviour in psychiatric in-patient settings.
Restrictive practices fall under the medical domain & consultation with industry experts is important.
‘Patient physical & chemical restraint policy” of Safdarjung Hospital, New Delhi is attached for reference.
The document can be accessed on https://vmmc-sjh.mohfw.gov.in/ or downloaded here (Restrains Policy Safdarjung Hospital) or can be viewed below