Mental Health Nursing, Mechanical Restraint Measures and Patients’ Legal Rights

Abstract: Coercive mechanical restraint (MR) in psychiatry constitute the perhaps most important exception from the
common health law requirement for involving patients in health care decisions and achieving their informed consent prior
to treatment. Coercive measures and particularly MR constitute a serious collision with patient autonomy principles, pose
a particular challenge to psychiatric patients’ legal rights, and put intensified demands on health professional performance.
Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented.
This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by
untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings
and especially when health professional documentation is scant, patients’ rights call for taking notice of patient
evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient’s
mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light
potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and
promote patients’ rights, education of forensic psychiatry professionals must address the need for, as far as possible,
paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation
requirements.