Coercive practice and mental health reform

Question 1

what is coercion?

Answer 1

= concept of coercion refers to the Use of power with the aim of applying some degree of unwelcome pressure on an individual
• The use of power can involve a continuum of influence to obtain compliance or agreement
• “practice of persuading someone to do something by using force or threats”

Question 2

Name the three coercive practice techniques?

Answer 2

1. seclusion and restraint
2. community treatment orders (CTO)
3. enforced medicaitions

Question 3

What is seclusion?

Answer 3

= confinement of a patient in a room or area from which free exit is prevented

• Gets used: aggression substance use/intoxication, safety of person, staff and other
• Consumers say: Physical aggression against patients, Lack of social and psychological support , The need for improving or replacing the practice of seclusion

Question 4

What is restraint?

Answer 4

= defined as the restriction of an individual’s freedom of movement by physical or machinal means
• Controversy –> physical restraint increases the risk of injury to staff as well as the service users
• Can lead to cardiac deterioration and even death by cardiac arrest

Gets used: after seclusion, any hands on activity, can be used in a cisis

Question 5

What is CTO?

Answer 5

Community treatment orders = legal orders authorising compulsory treatment of people able to be effectively treated out of hospital as an alternative to involuntary hospitalisation

• CTOs are not an intervention but a mechanism of ensuring contact with services where interventions may then occur. It’s critically important that service’s understand what they are being used for and what they are meant to achieve

Question 6

What is enforced medications?

Answer 6

= chemical restraint is also an issue
• Implementation of a policy prioritising enforced medication over physical restraint showed a 363% increase in medication use

Question 7

Why do CTOs get used?

Answer 7

• medication noncompliance, reduce rapid relapse, ensure service engagement, ensure adequate medication in individuals at risk of aggression and at the request of families
• Consistent treatment is important and often there is no way to ensure people receive such treatment due to inadequate services and resources in the community
• CTOs are one mechanism to ensure people receive consistent medication.
• • CTOs are intended to ensure least restrictive care and reduce the need for hospitalisation which can be distressing and limiting. Assumptions that all orders are harmful, overlooks the potential harm of repeated relapse and crisis intervention.

Question 8

How do nurses contribute?

Answer 8

• Fitting into the system
• Doing what has to be done
• Expectations of team
• Getting through the day
• Fear
• Lack of experience
• Burnout