Mental Health Nursing, Mechanical Restraint Measures and Patients’ Legal Rights



Soren Birkeland1, 2, *, Frederik A. Gildberg1
1 Research & Development Unit, Department of Psychiatry, Middelfart, Region of Southern Denmark & Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
2 Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Denmark


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© Birkeland and Gildberg; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Research & Development Unit, Department of Psychiatry, Middelfart, Region of Southern Denmark & Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Oestre Hougvej 70, 5500 Middelfart, Denmark; Tel: 00 45 65508321; or Private Address: 15 Cedar St, Cambridge MA 02140, US; Email: sbirkeland@health.sdu.dk


Abstract

Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular challenge to psychiatric patients’ legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented. This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients’ rights call for taking notice of patient evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient’s mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and promote patients’ rights, education of psychiatry professionals must address the need for, as far as possible, paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation requirements.

Keywords: Coercive measures, legal rights, mechanical restraint, mental health nursing, professionalism, psychiatry, shared decision making.