Within mental healthcare, coercive practices are those that restrict freedom and force interventions to immediately de-escalate potential crisis. It is rare to find such practices elsewhere, yet they are common in mental healthcare (namely the use of restraints and seclusion). Restraint means the use of a device to prevent a person from moving his/her body. Seclusion means the placement of an individual alone in a locked room from which he/she is prevented from leaving. These practices are associated with physical injury, trauma and a detrimental impact on therapeutic alliance. The World Health Organization (WHO) positions the use of restraint and seclusion (R/S) as an infringement on human rights. Ontario Shores Centre for Mental Health Sciences adopted the WHO’s Human Rights Standards to drastically reduce the use of R/S within the hospital.
Beginning in 2016, Ontario Shores made an effort to reduce the use of R/S by engaging patients and staff to identify and implement de-escalation alternatives such as “Safewards,” crisis intervention planning and real time incident monitoring of the use of R/S. The use of R/S often results from tension, power imbalances, and conflict on the unit. Safewards and the crisis intervention plan are designed to mitigate these incidences while minimizing the power imbalance inherent within the “us” and “them” relationship that can occur between staff and patients.
The implementation of these interventions as well as ongoing monitoring of R/S use has drastically reduced coercive practices at Ontario Shores; minimizing staff and patient injury – ultimately creating a safer treatment environment.