Restrictive practices in health care and disability settings : legal, policy and practical responses / edited by Bernadette McSherry and Yvette Maker.

Format:

Book

Contributor:

McSherry, Bernadette, editor.

Maker, Yvette, editor.

Series:

Biomedical law and ethics library.

Biomedical law and ethics library

Language:

English

Subjects (All):

Medical care--Law and legislation.

Medical care.

Physical Description:

1 online resource (310 pages) : illustrations (black and white)

Edition:

1st ed.

Place of Publication:

London ; New York, New York : Routledge, 2021

Summary:

This volume explores different models of regulating the use of restrictive practices in health care and disability settings. The authors examine the legislation, policies, inspection, enforcement and accreditation of the use of practices such as physical, mechanical and chemical restraint. They also explore the importance of factors such as organisational culture and staff training to the effective implementation of regulatory regimes. In doing so, the collection provides a solid evidence base for both the development and implementation of effective approaches to restrictive practices that focus on their reduction and, ultimately, their elimination across health care sectors. Divided into five parts, the volume covers new ground in multiple respects. First, it addresses the use of restrictive practices across mental health, disability and aged care settings, creating opportunities for new insights and interdisciplinary conversations across traditionally siloed sectors. Second, it includes contributions from research academics, clinicians, regulators and mental health consumers, offering a rich and comprehensive picture of existing regulatory regimes and options for designing and implementing regulatory approaches that address the failings of current systems. Finally, it incorporates comparative perspectives from Australia, New Zealand, the Netherlands, Germany and England. The book is an invaluable resource for regulators, policymakers, lawyers, clinicians, consumer advocates and academics grappling with the use and regulation of restrictive practices in mental health, disability and aged care contexts.

Contents:

Cover

Half Title

Series Page

Title Page

Copyright Page

Contents

List of figures

List of tables

Table of cases

Table of statutes

Abbreviations

Acknowledgments

List of contributors

PART I Background: rationales and options for reform

1 Restrictive practices: options and opportunities

Introduction

Definitions and scope

Background: the wider context and options for reform

The role of regulation and its limits

Implementing and monitoring regulatory change

Challenging risk, fear and blame: the need for complementary culture and practice change

2 Ending restraint: an insider view

Situating ourselves

Background

Minority groups and restraint

Defining restraint

Intersectionality of restraint

Direct restraint

Restraint on bodies and associated harms

Restraint on minds and associated harms

Restraint on freedoms and associated harms

Indirect restraint and associated harms

Restraint and harms to self-hood

Restraining impact of a biogenetic paradigm

Eliminating restraint

Why 'reducing' is not enough

What next?

Fast forward to 2050: finally, the mad are free

Key historical events leading to the abolition of all forms of restraint

Conclusion

PART II Designing legislation and policy to support change

Introduction to Part II

3 Human rights and rapid tranquillisation

The data set

The overall structure of the policies

Overall objectives and context

Procedural issues

Rapid tranquillisation and care planning

Implementing rapid tranquillisation

Procedures following rapid tranquillisation

The medications

Route of administration and rapid tranquillisation drugs

Evidence-based practice, rapid tranquillisation and human rights

Legal contexts

Conclusion.

4 The regulation of restrictive practices on people with intellectual impairment: the challenges and opportunities posed by a rights-based approach

The use of restrictive practices to respond to behavioural issues

Why the use of restrictive practices must be regulated

The current regulatory approach in Australia

Current sources of authorisation for restrictive practices

Does legalism offer the best way to address regulatory gaps?

A rights-based approach to safeguarding the rights to liberty and security

A rights-based approach to equality: moving beyond 'legalism'

Applying a rights-based approach to equality in the regulation of restrictive practices

5 Beyond restraint: gender-sensitive regulation of the control of women's behaviour in Australian mental health and disability services

A note on terminology

Research on the gendered dimensions of restraint

Services ignore the relevance of gender to women's needs and experiences

Gender, trauma and restraint are interrelated

Essential elements of gender-sensitive, trauma-informed practice

Enhance gender awareness and challenge stereotypes

Focus on relationships

Recognise trauma and avoid perpetuating it

Does existing Australian regulation promote gender-sensitive, trauma-informed services?

Gender needs and gender-sensitivity in legislative principles

Restraint-specific gender considerations in legislation, policies and guidelines

Sketching a comprehensive approach to regulation

Legislation

Policies and guidelines

6 Attempts to reduce the use of restrictive interventions in England between 2014 and 2019

Context

The policy initiatives and their impact

Positive and Proactive Care

Mental Health Act Code of Practice 2015.

National Institute for Health and Care Excellence guidance

The second tranche of initiatives

Should any restrictive interventions be prohibited?

Reducing restrictive practice is not a stand-alone issue

Additional actions and approaches

PART III Implementing and monitoring reform

Introduction to Part III

7 Legal regulation and policy on the use of restraint and coercive measures in health care institutions in the Netherlands

Overview

Introduction to the Dutch (mental) health care system and terminology

The (mental) health care system in the Netherlands

Terminology

The legal framework regulating the use of involuntary treatment, coercion and restraint in Dutch health care institutions

The Psychiatric Hospitals (Committals) Act (Bopz)

The Compulsory Mental Health Care Act (Wvggz)

The Care and Compulsion (Psychogeriatric and Intellectually Disabled Patients) Act (Wzd)

The Health Care Inspectorate and the Argus register: hopes, achievements and controversies

Overview of the tasks of the Health Care Inspectorate

Establishment of the Argus register

Achievements and controversies

Trends and developments in the use of coercive and involuntary measures in psychiatric institutions

A reduction in the use of seclusion

Dutch interventions to reduce coercive and involuntary measures

8 Queensland's new physical restraint framework: implementation and lessons since the commencement of the Mental Health Act 2016

Developing Queensland's broader mental health regulatory framework

A new regulatory system for physical restraint

Changes to the regulation of mechanical restraint

How were the reforms implemented?

Issues and barriers arising from the implementation of the Mental Health Act 2016

Internal review of physical restraint practices.

Evaluation of the Mental Health Act 2016 implementation

Data regarding the use of, compliance with, and monitoring of physical and mechanical restraint for the Mental Health Act 2016

Discussion

9 Showing restraint: the uses and limitations of data in supporting restraint reduction

Stages of data development and use

Stage 1: defining the construct

Stage 2: operationalising the definition

Stage 3: defining indicators

Stage 4: data collection

Stage 5: feedback and reporting

Stage 6: interpretation and action

Measurement issues for different types of restrictive practice

Seclusion

Physical and mechanical restraint

Chemical restraint

Summary and conclusions

10 The Court, the law and German psychiatry's slow progress towards human rights

From Prussian psychiatric law to the legal and economic basis of modern German mental health care

The state inspectorate for psychiatry in the German state of North Rhine-Westphalia: personal reflections on the role and limits of this body

The German Federal Constitutional Court's decision on the use of physical restraints in psychiatric care (July 2018)

Implementation of the new restraint ruling: a challenge for lawmakers, psychiatric staff and society as a whole

Milder measures and a change of traditions: what is needed

Summary and outlook

PART IV Changing culture and practice

Introduction to Part IV

11 The intractable use of restraint, organisational culture and 'othering': lessons from the Oakden scandal

The Oakden scandal

Organisational culture: beyond last resort to convenience

Justifications for the use of restraint

Societal culture: risk of harm and common beliefs and practices

12 Being recovery-oriented and reducing the use of restrictive interventions in mental health care: the challenges in achieving transformation

The drivers of and barriers to change

Factors driving less restriction

Factors driving the ongoing use of restriction

The limited evidence for interventions to reduce restrictions

The invisibility of restraint and other restrictive interventions in policy and practice guidance

Common themes in qualitative findings regarding restrictive interventions

The need to reduce boredom in wards

The value of peer support workers

Choice and control

Continuity, quality and experience of staff

Addressing problems with inpatient environments

Tolerating risk and addressing fear

Recognising trauma

Acknowledging dehumanisation and 'othering'

Listening, respect, compassion and hope

Addressing the culture of wards and overall organisational culture

More staff, more resources and more money

13 Psychotropic use in Australian aged care homes: what can be done to ensure appropriate use?

Psychotropic medications

Prevalence of psychotropic use in Australia

International psychotropic medication use

Factors underlying psychotropic use

Chemical restraint? the term is very much open to interpretation

Strategies to reduce psychotropic use

Regulation and mandatory public reporting

Safety warnings and policy

Australian initiatives to address psychotropic use

Residential medication management review and quality use of medicines programme

Focused interventions

Conclusions

14 Engaging doctors to reduce restraint: practice and pragmatics around restraint in clinical care

The regulation of restrictive practices and clinical practice

Reducing restraint was done a long time ago.

Hill's 1839 treatise on 'Total Abolition of Personal Restraint'.

Notes:

Includes bibliographical references and index.

Description based on print version record.

ISBN:

0-429-35521-1

1-000-29015-8

9780429355219

OCLC:

1223100744