Handcuffs in mental health facilities ‘sends all the wrong messages’, says watchdog

Handcuffs were used 18 times as mechanical restraints at the Central Mental Hospital (CHM) in Dundrum, a new report states.

The Mental Health Commission (MHC), the review body for mental health facilities in the State, has revealed that the incidences of handcuffs being used in the Central Mental Hospital were among 6,747 occasions when restrictive practices, such as physical restraint and isolation, were used in 2019.

MHC chief executive John Farrelly. said handcuffs were a “stark reality which reminds us of what restrictive practices can mean for people.

“The fact that we are still using handcuffs to restrain people sends out all the wrong messages and is simply not reflective of what a modern mental health service should look like.”

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He described restrictive practices as having a “lasting and traumatising impact” on patients which should only be authorised in the strictest of circumstances and only in accordance with rules set down by the MHC.

The figure of 6,747 instances shows a 10 per cent decrease on the 7,497 cases recorded in 2018, but a 42 per cent increase on the use of restrictive practices in 2008.

Of the 6,747 episodes, 1,796 involved seclusion or physical restraint.

Physical restraint was the most frequently used restrictive intervention. It was used in most centres and accounted for 75 per cent of all interventions in 2019, compared to 76 per cent in 2018.

Seclusion accounted for 25 per cent of restrictive interventions in 2019, compared to 24 per cent in 2018.

The only use of mechanical restraint was the CMH where handcuffs were used.

Mr Farrelly said the rise of 42 per cent in reported cases is down to better reporting and that previous instances of restraint were not reported.

“ This is why the MHC launched its reduction strategy to raise awareness and prompt providers to fully identify all practices which needed to be discontinued or reduced,” he said.

He stressed the MHC’s campaign to reduce the number of restrictive practices may have led to greater awareness among professionals about using restrictions.

“The current evidence is that there is no therapeutic effect linked to the use of restraint. People are gaining an increasing understanding that in the buildings which are designed well, where there are effective staffing arrangements, there should be very limited need for these practices,” he said.

He suggested that the levels of physical restraint and seclusion were not decreasing at a rate that would suggest that these practices are slowly but surely disappearing from our mental health services.

He said that if the health services were serious about eradicating restrictive practices, mental health facilities would have to be upgraded and staff training increased.

“Ultimately, we want to reach a position where we only see these practices applied in very limited and exceptional circumstances,” he said.

“The culture of using restrictive practices in this country must be properly examined. We must ask ourselves if we are happy, as a society, to continue restraining or secluding hundreds of very unwell people in buildings up and down the country every year.

“The MHC recognises that human rights are paramount when it comes to how people are treated and cared for. Every person who accesses mental health services must have their human rights vindicated and have their dignity, bodily integrity, privacy and autonomy respected.”