Is it time for international guidelines on physical restraint in psychiatric patients?

Clin Ter. 2019 Jan-Feb;170(1):e68-e70. doi: 10.7417/CT.2019.2110.


The freedom-restraining measures used during Involuntary Health Treatment (IHT) are highly criticized in the medical community. Physical restraint techniques are currently largely used worldwide in Psychiatry. The use of restraints against the patient's will can be considered a serious intrusion of basic human rights and even an act of violence against the patient. In all cases, the restraint should not lead to injuries or damage to the patient's health and should be implemented with a respect of the human rights and dignity. Generally, the use of restraint should be considered as a last resource, when all the other methods have failed. Since it represents the principal freedom-limitation measure, it should be constantly monitored by physicians who apply these methods. The case of a 58 years-old white male, affected by chronic schizoaffective disorder and cannabinoid dependence, was under involuntary medical treatment as a consequence of antisocial behavior. During the IHT he suffered firstly a pharmacological restraint and then a physical restraint in order to suppress a slight state of agitation. The patient was completely blocked to the bed for more than 80 hours and died after three days of hospitalization. The aim of this study is to evaluate the suitability of restrictive methods for psychiatric patients in order to establish specific rules to prevent abuse of restraint techniques and even to help physicians to treat psychiatric patients.

Keywords: Forensic Psychiatry; Legal Medicine; Medical liability.

Publication types

  • Case Reports

MeSH terms

  • Hospitalization
  • Human Rights
  • Humans
  • Male
  • Middle Aged
  • Psychiatry / methods*
  • Psychiatry / standards
  • Psychotic Disorders / therapy*
  • Restraint, Physical / standards*
  • Violence