Management of agitation in mental health settings

Abstract

Introduction: mechanical restraint (MR) is a practice currently permitted in Spain for use in healthcare centres. It is an exceptional therapeutic measure of controversial use. Research related to MR describes traumatic experiences for the patient and staff, so it may entail an ethical dilemma for healthcare professionals and favour the patient’s regressive behaviour. Objective: to compile the recommendations and scientific evidence regarding the management of agitation in order to reduce the use of MR and the secondary problems of the approach. Material and methods: a literature review through consultation of the following databases: CINAHL, PubMed/Medline and Google Scholar. The following controlled vocabulary was used: “agitation”, “mechanical restraint”, “verbal de-escalation”, “nursing intervention” and “mental health” with free language, combining them with the Boolean operators AND and OR. Results: a total of 46 articles were analysed. The following concepts related to alternatives to MR in mental health settings were identified and clarified: 1) zero restraint, 2) legality of MR, 3) prevention, fundamental to avoiding MR, 4) environmental and organizational management, 5) pharmacological intervention, 6) verbal de-escalation, 7) MR and 8) therapeutic relationship. Discussion and recommendations: MR continues to be part of everyday psychiatric practice. Serious adverse effects are associated with the use of seclusion and restraint; hence the need to find alternative treatment strategies. It is useful to remember that certain reforms —which, at first, may create unease among staff— can be quite successful.