Self Harm Is not a Reason to Impose Restraints
The authors deserve thanks for their clear explanation from a forensic medical perspective. The article refers primarily to patients in homes for elderly people and nursing homes. With regard to the authors’ observations relating to psychiatry, however, I wish to raise several objections. It is not the case that restraints in psychiatry are used primarily to prevent patients from self harm and attempted suicide. The articles cited by the authors in support of their statement—including one of mine—do not show this. Restraints to prevent self harm and suicide are regarded as inappropriate in the psychiatric setting, with the exception of extreme cases. Such problems need to be approached by means of qualified, intensive, interpersonal therapy. In the psychiatric setting, those most affected by restraining measures are patients with dementia—for the same reasons that are mentioned in the article itself, mostly to prevent (primarily nocturnal) falls with severe injuries. In other diagnostic groups, the most common reasons are threatening and manifestly aggressive behaviors, such as has been described in the article by Kallert et al (2007), which the authors cite. With regard to the legal regulations mentioned in the article, clarification is required: freedom restraining measures (FRM) because of aggressive behavior are permitted only in the acute emergency setting (according to paragraphs 34/35 of the German Penal Code, justifiable emergency) or, under German public law, in the context of admission to psychiatric hospitals according to state law. According to the guardianship law, which applies exclusively in nursing homes and non-psychiatric hospitals, freedom restraining measures are allowed only for the benefit of the affected patient, but not to avert danger to third parties.
Prof. Dr. med. Tilman Steinert
Zentren für Psychiatrie Südwürttemberg
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Berzlanovich AM, Schöpfer J, Keil W: Deaths due to physical restraint. Dtsch Arztebl Int 2012; 109(3): 27–32 .VOLLTEXT|