Recently in the Netherlands, Dutch TV showed footage of a teenager known as ‘Brandon’ who was resident in a long stay institution. Because of his challenging behaviour, he was managed in this institution by the use of a harness, which was attached via a leather strap to a metal bracket on the wall. Dutch psychiatrists have been quoted as stating the practice of using such restraints may not be confined just to the ‘Brandon’ case.
There has been a significant public debate about the issue in the Netherlands, with legislators putting forward a set of policy proposals in a ‘Care and Coercion’ Bill to support the reduction in the use of restraints.
The authors of this literature review set out to look at how such issues were dealt with in countries such as the UK in order to identify possible lessons to be learnt.
They identified that although the use of restraints in people with learning disabilities is internationally regulated by the principle of ‘last resort’, that policy did not always appear to be in line with practice.
They found studies of best practices which identified a range of factors that were important in reducing the use of restrictive interventions, including
- strong leadership based on clear national policy,
- good quality training for staff
- clear and rigorously applied monitoring systems.
They also noted that positive attitudes and constructive approaches to behavioural change meant that the use of restraints was identified as treatment failure.
In the context of the Dutch experience however, they noted that the dilemmas associated with the use of restraints and the efforts to reduce such use, are being faced internationally.
They recommend that whilst work continues on ratifying a legal framework for the Netherlands, ratification of the UN Convention on the Rights of Persons with Disabilities, could be made.
Restriction on Restraints in the Care for People With Intellectual Disabilities in the Netherlands: Lessons Learned from Australia, UK, and United States, Romijn, A & Frederiks, B, in Journal of Policy and Practice in Intellectual Disabilities, 9: 127–133.
You can view the link to the BBC news item on the ‘Brandon’ case here