Dr. Imelda Whyte:

On that last question regarding the use of restraints, all types of restraint and seclusion are the last option and the last resort. The Mental Health Commission, which is the agency that monitors and licenses approved centres and inpatient units for both adults and children, has specific regulations and guidelines around the use of restraint, including mechanical restraint.

Restraint and seclusion are words that have a lot of highly negative connotations and they absolutely should only be used as a last resort but I would add a caveat. Imagine a situation where there is a young person - I am going to talk about a young person because I work with younger people - who is acutely psychotic, a danger to himself or herself and potentially a danger to the other people in the environment. We know the young person is psychotic and needs medication but will not take that medication willingly. In that situation, the option is to let a very difficult situation progress to a point where somebody gets hurt, possibly another young patient in the environment, someone who might only be 11 or 12, or to make a clinical judgment call that this is a psychotic presentation, that the young person can be treated with medication but is not currently able to co-operate to take it orally and requires an intramuscular injection. For that to happen safely, a restraint might be necessary. It is important not to make general statements that restraint is bad and seclusion is bad. They have their role and their place and there are specific guidelines and protocols in place by the regulating authority, which is the Mental Health Commission. It collects data on the use of restraint and it monitors its use closely. When the units are inspected, we have to explain its use to the commission.