*Trigger Warning: This post discusses medical restraints and mental health hospitalization*
*Disclaimer: This is a personal account and not professional medical advice.*
In the world of inpatient mental health care, restraints are a harsh reality that few people outside the system truly understand. Every staff member in an inpatient hospital has a story about having to restrain patients. They often believe they're protecting the individual—from themselves or protecting others. And to be clear, there are absolutely moments when some form of intervention is necessary to save a life,
but the truth is far more complex. Restraints are not used as a last resort; they've become a default response, a quick solution to complex human experiences of distress.
The laws surrounding restraints are frustratingly ambiguous. Professionals are allowed to use "reasonable force," a term so broadly defined it becomes almost meaningless. In a training session, I was told that "reasonable force" is anything equal to or below the perceived threat but perception is a dangerous tool in high-stress environments. Something as simple as the words used in handover can completely change a staff members view on a service user and the level of risk they present. In the heat of the moment, a minor agitation can be blown out of proportion. The staff's perception of risk becomes distorted by stress, fatigue, lack of understanding, and systemic pressures. What might be a momentary emotional outburst becomes seen as a potential crisis.
Physical restraints are only part of the story. Chemical restraints were something I wasn't fully aware of at the time—primarily because I was so heavily medicated that functioning became impossible. I was zombified, trapped in a haze so thick that reality became almost meaningless.
In my brief moments of awareness, the overwhelming sense of hopelessness would drive me to self-harm attempts. I vividly remember being transferred between units and being given full doses of PRN (as-needed) medication. The world became disconnected—walls seemed to move and shift around me in a surreal, detached landscape. I was so deeply sedated that you could have potentially set me on fire, and I wouldn't have truly noticed.
These chemical restraints were just as controlling as physical restraints, perhaps even more insidious because they stripped away my ability to perceive, to react, to be human. Mental health professionals can administer medication against the will of a sectioned patient, whilst in some cases this is vital, this can be abused. Medication is a tricky subject within mental health care, as we don't really understand why or how they work. Some peoples lives are saved by the use of psychiatric medication, and to some degree I'm one of these people however I have personally found less is more, being over prescribed medication made it difficult to heal. I felt that the drugs were a sticking plaster for a much bigger wound. I also feel in hospital there can be a attitude amongst service users that the more medication your on, the more poorly you are, the more worthy of care you are.
The overuse of restraints is a symptom of deeper, systemic problems in mental health care:
Staffing Shortages: Inpatient units are chronically understaffed, with high demands and low retention rates. Working in a inpatient hospital is extremely stressful and traumatic, they are witnessing horrific things daily, and often those on the ward day to day aren't paid or valued adequately. Anyone who is good at there job progress up the career ladder, and move into jobs that have less patient contact . There is a lack of permeant staff and a heavy reliance on agency staff.
Lack of Continuous Training: Staff rarely have the time or resources to develop deep understanding of individual patients. They don't have the time to receive the education and training they need to understand their role and the importance of it. Whilst delivering training i have had professionals comment that they had never thought of restraints in the way i spoke about them, that they never thought about the further trauma they may be causing.
Breakdown of Therapeutic Relationships: The constant rotation of agency and permanent staff prevents the development of meaningful, trust-based connections. often the training given to staff gives the opinion that they shouldn't build relationships with service users. whilst they shouldn't be discussing intimate details about their own lives, the building of professional relationships is imperative to being able to understand the service user. I fundamentally believe that the relationship you have with the service user is the main tool for helping that service user.
In the pressure cooker of an inpatient unit, something strange happens. Everything becomes magnified. Small incidents become massive conflicts. Things that i would now leave, then felt pivotal to my existence. I remember a incident where my dinner arrived at the unit and it was just a bowl of cheese, (food is a massive deal in inpatient units, its often one of the only bits of control or comfort you have), now it wouldn't be a issue. I would be able to get something else, pop to the shop and buy myself something, look in the kitchen cupboard and find something but in that moment I was distraught. It made me feel like nobody cared about me, that they wanted me to suffer. I led on the floor a sobbed, staff at the time didn't appear to see why it was such a big issue to me.
And when you're sectioned, you lose the "flight" option in the fight-or-flight response. You're left with only fighting or freezing.
I reached a point where—without fully realizing it—I would deliberately do things that would result in restraint. A form of self-harm, really. Looking back, it felt almost like an inevitable dance. The staff seemed to have an attitude of "this is the easiest way," while I thought, "They're going to restrain me anyway, so why not?". I didn't understand why i would put myself in positions where I ended up being restrained, looking back I can think of times where I was restrained by 4 people who were a lot larger than me over things that wouldn't of killed me or harmed anyone else. I see the restraints as being knee jerk reactions, where there was the time to take a minute to think about alternative options. I think the staff carried a lot of fear, which then made them react in unhelpful ways often escalating the situation further. I have received care in the community and they never had to restrain me, but the difference is they got to know me really well, they had the time to be able to get to know what my triggers and signs looked like. they were able to intervein a lot sooner before I reached crisis point.
Communication is the most critical and most overlooked tool in preventing restraints. Effective de-escalation requires a deep understanding of the individual in order to be able to recognition of early warning signs. This gives professionals more time and space to intervene before situations escalates.
There needs to be a genuine empathy and connection, between service user and professional, too often, a lack of understanding turns a manageable situation into a crisis.
Even though it's been five years since my last physical restraint, the experience continues to haunt me. Nightmares still plague my sleep, transporting me back to those moments of complete loss of control. The trauma doesn't end when you leave the hospital—it follows you.
Alarms have become triggering reminders of those moments of restraint. The sound alone can send me spiralling, reconnecting me to those intense, overwhelming experiences. Physical contact has become a minefield of emotions. While some of my difficulty with touch stems from trauma I experienced before being sectioned, the experiences of physical restraint have undoubtedly intensified this struggle.
These are the hidden wounds of restraint—the psychological scars that aren't immediately visible but cut deep into one's sense of safety, autonomy, and trust.
What Can Change?
Real transformation requires a fundamental shift in approach:
1. Comprehensive Training: Invest in deep, ongoing education for mental health professionals
2. Prioritize Relationship-Building: Create environments that value human connection over control
3. Trauma-Informed Care: Develop approaches that recognize the long-term impact of interventions
4. Patient Autonomy: Empower patients and involve them in their own care plans
5. Mental Health Resources: Increase funding for mental health services and support
If you've experienced medical restraints, you're not alone. Your feelings are valid. Your experience matters. Healing is possible, and your voice is important.
*Disclaimer: This is a personal account and not professional medical advice. If you are experiencing mental health challenges, please seek support from qualified professionals.*
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