Health

October 17 2016

Why restraint is not the solution

the Psychlopaedia team
By The Australian Psychological Society

Use of physical restraint in detention settings is outmoded, according to a leading expert, and amounts to a physical assault that would be unacceptable in any other setting.

The use of restraint in Australia’s juvenile justice system to control challenging youth has made media headlines, garnering national attention and widespread outrage.

But these are not one-off incidents. Restraints, including seclusion (isolation), physical, chemical (medication) and mechanical restraints, are frequently used across Australia.

These restraints are designed to control people in a range of settings, from youth in detention to people with intellectual disabilities either living in a community setting or in the family home.

On the back of a large body of research which shows restraint tactics are not effective, there are growing calls to eliminate the use of restraints in youth detention, prisons, schools and in services for people with intellectual disabilities.

Why restraints should not be used

In recent years, restraints have increasingly been considered an inhumane treatment that breaches people’s fundamental human rights under a range of United Nations conventions, covering the rights of children, prisoners and people with disabilities.

Professor Keith McVilly MAPS*, a registered clinical psychologist and researcher at the University of Melbourne, says using restraints is a form of abuse.

“If we were doing it to anybody else on the street, it would be assault and if we did it to anybody else in our family it would be called domestic violence. But in the disability space and in the youth justice area, we call it a restrictive intervention and we get away with it,” he says.

“It’s really important to call it for what it is – at the end of the day, these are situations of domestic violence and circumstances of assault.”

Professor McVilly says restraints fail to address the individual’s problem behaviours.

“Restraints don’t change people’s behaviour for the better, they don’t teach people a better way to act, and they don’t meet the legitimate needs of people,” he says.

“If we understand what the person is trying to communicate and we use strategies that are designed to answer what the person is asking for, to provide the support, the information or the basic needs of the person, then we can change their life for the better.

“But just using restraints doesn’t answer those basic needs.”

Restraints are also incredibly dangerous. Individuals are often injured or could die as a result of restrictive practices, Professor McVilly says.

“When it comes to physical restraint, where people are set upon by staff and are physically restrained, they end up with fractured ribs that puncture lungs – people can go into respiratory arrest and have a heart attack as a result of the shock,” he says.

“It’s downright dangerous and often times it’s deadly.”

The impact of restraints

A growing body of evidence shows restrictive practices may not only lead to physical injury but they can also result in long-term psychological injury.

“The issue of long-term trauma is very real. We certainly see young people having been subject to these restraints coming into adult services in very traumatised states presenting with the classic symptoms of Post Traumatic Stress Disorder (PTSD),” Professor McVilly says.

“We’re seeing perpetuated heightened levels of anxiety, and we’re seeing people who fail to be able to connect significantly with others in any sort of meaningful relationship.”

The best approach

Research shows a range of psychological interventions are effective and considered best practice in targeting underlying, challenging behaviours across a range of settings.

Positive Behaviour Support (PBS) is an approach that seeks to understand what the individual with the challenging behaviours is trying to achieve.

“We develop strategies which, in the first instant, change the environment for the person so that the environment is better able to meet the person’s needs, and less likely to give rise to the person needing to use that particularly maladaptive, disruptive or dangerous behaviour,” Professor McVilly says.

“We then teach the person an alternative behaviour, an alternative way of telling us what they’re feeling or what they want to achieve.

“Another really important component of PBS is teaching people how to cope.”

Professor McVilly says carers and staff can also use trauma-informed care, a gold standard in treatment interventions, to build all-important relationships.

“Trauma-informed care is a very different approach to simply saying – this person has a deficit that we’re going to treat,” he says.

“It’s actually acknowledging that the person has had a whole history of experiences which have contributed to this particular circumstance.”

Another part of the solution is using training and education to up-skill carers and service providers.

Professor McVilly says staff and carers should be trained to provide functional assessments of problem behaviours before they attempt to devise strategies to address the behaviours.

Most importantly, staff and carers need to look beyond the challenging behaviour, he says.

“Realise that most of the time the person is just doing the best that they can to tell you that something is wrong and they can’t cope on their own. To borrow from Martin Luther King Jr – ‘a riot is the language of the unheard’.”

 

  • Member of the Psychological Society of Australia