3 Dec 2020

New Zealand should end restraint use in mental healthcare - psychiatrist

4:09 pm on 3 December 2020

New Zealand needs to lower its use of mechanical restraints in mental healthcare, with the goal of abolishing the controversial practice altogether, a psychiatrist and academic says.

A bed with restraints, used in a Japanese psychiatric hospital

A bed with restraints, used in a Japanese psychiatric hospital Photo: RNZ / Luke McPake

Mechanical restraint is when devices are used to immobilise parts of a person's body. This can include using straps to tie a person to a bed or chair by their wrists, waist, shoulders and ankles, and using mittens to stop people using their hands.

The practice is controversial, and has been criticised by the United Nations Committee Against Torture. Risks associated with its use in mental healthcare include physical harm, and even death with prolonged use. The practice can also increase distress and cause trauma.

The family of a New Zealand man who was restrained for 10 days in a Japanese psychiatric hospital believe the practice caused his death.

The call to end it in New Zealand, by Dr Giles Newton-Howes, comes off the back of a new study he co-authored, which was released today.

It found New Zealand's rates of mechanical restraint use in mental healthcare are 300 to 3000 times lower than in Japan.

"We're doing much better than some countries, but we could be doing even better", Dr Newton-Howes, a consultant psychiatrist and associate professor of psychiatry at Otago University, said.

Dr Newton-Howes said there were "calls both from within the community of professionals as well as from patient advocacy groups that there's no requirement for mechanical restraint".

Globally, there were "pockets of service delivered" with no use of seclusion or restraint, but those pockets were within countries that did allow restraint and seclusion.

Dr Newton Howes said he believed that New Zealand could deliver a national mental health service without the use of restraint and seclusion.

"In my personal view, that's what we should be gunning for."

In 2017, for every million people living in Japan, 98.9 restraint events took place per day. In New Zealand the rate was 0.03.

"Despite some really good legal and ethical and policy statements about abolishing the use of mechanical restraints, that's not happening in New Zealand", Dr Newton Howes said.

Seclusion, restraint and compulsory treatment are overused, especially for Māori and Pacific peoples, within New Zealand's mental health system, the government's 2018 report on mental health and addiction found.

The report said both practices needed to be reduced.

Dr Newton-Howes said he hoped the study, published in the journal Epidemiology and Psychiatric Sciences, highlighted that there was still work to do in New Zealand to reduce and then abolish mechanical restraint use.

The analysis by Dr Newton-Howes and academics from universities in New Zealand, Australia, Japan and the United States, found that in 2017, for every million people living in Australia, 0.17 restraint events took place per day. The rate was 0.37 in the United States.

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Photo: infogram

When measured by restraints per 1000 bed days, variation between countries was less extreme. Rates were 0.92 in Australia, 0.143 in New Zealand, 1.48 in the United States and 44.1 in Japan.

Dr Newton-Howes said the "enormous variation in rates" could not be explained by differences in the severity of mental illness between countries.

"Patients in Japan simply cannot be 300 to 3000 times more behaviorally disturbed" than patients in New Zealand.

Research showed restraint use could be "highly retraumatising" for mental health inpatients who were in distress, which could negatively impact their treatment, Dr Newton-Howes said.

There was clear evidence to suggest that with prolonged use there was a risk of death, he said.

One of the paper's six authors is Martha Savage, a professor of geography at Victoria University in Wellington, mother of 27-year-old Kelly Savage who died in Japan after being tied to a bed in a psychiatric hospital for 10 days.

Since her son's death, Martha Savage has campaigned to end the use of mechanical restraint in Japan.

She said the way mechanical restraint was used in Japan was "like torture."

"They basically restrain the entire body. They don't let you move your feet, arms or your torso sometimes."

Martha Savage visits her son in hospital

Martha Savage visits her son in hospital Photo: The Savage Family

The United Nations Committee Against Torture says the use of restraint "should be avoided or applied as a measure of last resort, when all other alternatives for control have failed and for the shortest possible time".

Mechanical restraint use in mental healthcare should be reduced and ultimately abandoned, the committee says.

Specifically addressing Japan, the UN committee raised concerns about "the frequent use of solitary confinement, restraints and forced medication" in mental healthcare, saying such actions may amount to "inhumane and degrading treatment."

Dr Newton-Howes said he would like to see the release of data on mechanical restraint use in mental healthcare be made mandatory globally, so a similar study analysing of the practice worldwide could be done.

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