Take Down! Psychiatric Restraint

We've all seen the depictions of restraint of the psychiatric patient on some B-movie from the 70's or a low-budget sitcom:

The bestial patient throws chairs through the window, shattering glass and shreiking savagely. Six orderlies pounce simultaneously on the poor brute, whose struggles are fultile as the nurse jams a vial of sedatives into his jugular vein. His rigid body relaxes as the nurse coos, "Just another moment and this will all be over....."

I was expecting a toned-down version of this when I walked into my Psychiatric rotation, and was suprised by what actually happened when a patient had a major meltdown.

10 year-old Francisco was having a bad day, and loosing a Volleyball game sent him over the edge. He pushed down another kid and started running a very foul mouth.

Staff Intervention #1: Removed other children from the area and assigned a staff member to "talk him down." This involves calming words and setting limits verbally.

Francisco continued to swear at the staff member. Then, he picked up a chair as if to though it.

Staff Intervention #2: Placed Francisco in the Quiet Room (a padded room with a bed) with a staff member in the doorway. The staff member continued to talk him down.

Francisco continued to swear, and then spit at the staff member and on the walls.

Staff Intervention #3: Required that Francisco take a sedative, either in pill or shot form.

Francisco refused the pill, so a rapid takedown using as little force as possible to get the job done. He was then left to rest in the quiet room with a staff member watching from the doorway.

I was impressed that this team took every step possible to prevent a forced takedown and chemical restraint. I'ts not perfect, but three cheers for progress in Psychiatry care.