Never again ‘crazy to bind’. After the announcement of the Minister Hope at the Second National Conference For community mental health (the first appointment was in the now very distant 2001) the draft agreement was sent to the Regions and Municipalities to be then definitively approved by the State-Regions Conference. This is a historic step for the treatment of mental illnesses.
We want to reach, by 2023, a “definitive overcoming of the mechanical restraint in all places of mental health “. The practice is still used today in several facilities, especially for mandatory health treatments (the infamous TSOs).
A dangerous practice
The text highlights how in the Mental Health services “restraint is a widespread practice, sometimes routine even if submerged” and even if recent data are not available “the latest available data show that 85% of the structures resort to restraint and that this is usually accompanied by other limitations of personal freedom ”such as the closed door, the searches and the spoliation of people at the time of hospitalization and even of visiting family members.
Mechanical restraint, especially if prolonged, “produces negative psychophysical outcomes: organs and functions can be directly damaged by the pressure or poor positioning of the means of restraint. Skin abrasions, nerve compression, ischemia of limbs and organs are described in the literature. Furthermore, immobility can produce pulmonary thromboembolism, pressure sores and urethritis due to the use of the catheter when a person is tied up. The inauspicious outcomes reach death ”.
The document highlights how the operators resort to mechanical restraint due to “the aggression threatened or acted by the patient towards himself or others”. Furthermore, frequently the justification given is the lack of personnel but as the European Committee for the Prevention of Torture and inhuman or degrading treatment or punishment says “This motivation is fallacious”. In fact, research shows that the “variables that most affect the use of restraint are culture, the organization of services, the attitude of the operators who play a decisive role more than the severity of the patients and their psychological profile”.
The Ministry provides 7 recommendations to be adopted by the Regions.
– Activate paths of recognition of practices that limit personal freedoms
– Take initiatives to know and monitor mechanical restraint
– Guarantee training activities for all operators and operators
– Respect the rights and dignity of people
– Organize integrated, inclusive and locally rooted mental health and NPIA services
– Guarantee the quality of health centers and the accessibility of services
– Promote teamwork and networking