Transcript Otsikko Arial bold 32 pt

Restraints and coercive
methods in social care
16th EPSO Conference
Copenhagen 17.-18-9-2013
Hanna Ahonen
17-18.9.2013
Hanna Ahonen
1
Realisation of the right of self-determination
in 24-hour services within social welfare
in child welfare, services for people with disabilities, mental
health care services and
substance abuse care
Valvira reports 1:2013
17-18.9.2013
Hanna Ahonen
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Background
A joint implementation programme for three supervision
programmes completed in January 2012:
• 24-hour care and upbringing within child welfare,
• 24-hour residential services for people with disabilities,
• 24-hour residential services for persons undergoing
mental health and substance abuse rehabilitation and
institutional substance abuse care.
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Legal basis
Explicit legal provisions on restricting the right of selfdetermination are laid down in Finnish legislation only in
the Child Welfare Act, which entered into force after the
reform of the Constitution and which caters for the human
and basic rights of children
lack of a legislative framework a problem:
a working group working to consider the right to selfdetermination of clients in social welfare and healthcare
- to compile all provisions restricting the right of selfdetermination of patients and social welfare clients into a
single Act
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Aim of the report:
to determine the procedures and practices associated with the
realisation of clients' right of self-determination in use at
the operating units
Method:
Survey, supplemented with other materials as necessary
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24-hour care and upbringing within child
welfare
Table 4. Sanctions for rules infractions classified according to whether the unit had
prepared written rules/house rules (24-hour care and upbringing within child
welfare)
Sanction (always/sometimes)
House confinement
Ban on phone use
Ban on watching TV
Meal restrictions
Cancellation of home leave
Ban on computer use
Smoking ban / removal of tobacco products
Ban on coffee drinking
Ban on snacks
House/room arrest
Other
Total
Written house rules
Yes
No
38
8
34
10
36
12
1
2
25
4
44
14
49
14
10
4
3
2
16
8
12
3
62
23
NB. The data for three late-responding units are missing from the table.
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24-hour care and upbringing within child
welfare
Table 5. Guidelines on use of restrictive measures and measures used in care situations during the past
year according to whether the unit had prepared guidelines on their use (24-hour care and upbringing within child welfare)
NB. The data for three late-responding units are missing from the table.
Used during the past year
Physical guidance
Physical restraint
Weighted blanket
Treatment shirt (restrictive clothing)
Safety helmet
Safety mat
Regular mat
Restraints
Sedatives
Locking doors
Diaper suit (restrictive clothing)
Restriction of freedom of movement
Restriction of contact
Confiscation of substances or objects
Bodily search
Withholding of property and deliveries
Inspection of client’s room
Special care
Drug testing
Breathalyser
Blood test
Isolation
Other
Total
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Hanna Ahonen
Guidelines on use of restrictive
measures
Yes
No
32
5
33
9
0
0
0
0
0
0
0
0
1
1
4
1
10
4
0
0
0
0
34
9
19
8
30
10
25
6
8
1
32
10
9
5
27
7
25
8
2
0
10
3
4
0
48
37
7
units providing 24-hour services for
people with intellectual and
developmental disabilities
Table 8. Sanctions for rules infractions classified according to whether the facility
had prepared written rules/house rules (units providing 24-hour services for people
with intellectual and developmental disabilities)
Sanction (always/sometimes)
House confinement
Ban on phone use
Ban on watching TV
Meal restrictions
Cancellation of home leave
Ban on computer use
Smoking ban / removal of tobacco products
Ban on drinking coffee
Ban on snacks
House/room arrest
Other
Total
Written house rules
Yes
No
4
10
6
9
2
3
0
6
3
4
4
4
4
4
4
7
2
2
2
5
4
3
24
45
Total
14
15
5
6
7
8
8
11
4
7
7
69
“The sanction is e.g. an ‘in-house day’ during which the
residents attends to personal laundry, room cleaning.”
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intellectual and developmental disabilities
Table 9. Measures used in care situations during the past year according to
whether the unit had prepared guidelines on the use of restrictive measures (units
providing 24-hour services for people with intellectual and developmental
disabilities)
Used during the past year
Physical guidance
Physical restraint
Weighted blanket
Treatment shirt (restrictive clothing)
Safety helmet
Safety mat
Regular mat
Restraints
Sedatives
Locking doors
Diaper suit (restrictive clothing)
Restriction of freedom of movement
Restriction of contact
Confiscation of substances or objects
Bodily search
Withholding of property and deliveries
Inspection of client’s room
Special care
Drug testing
Breathalyser
Blood test
Isolation
Other
Total
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Guidelines on use of restrictive measures
Yes
No
Total
14
32
46
7
17
24
5
2
7
2
0
2
2
7
9
1
0
1
0
1
1
1
1
2
14
23
37
5
5
10
11
5
16
8
17
25
2
6
8
7
18
25
3
6
9
0
0
0
6
14
20
7
20
27
0
0
0
0
1
1
1
0
1
3
1
4
4
3
7
23
46
69
9
24-hour services for people with physical
disabilities
Table 12. Sanctions for rules infractions classified according to whether the facility
had prepared written rules/house rules (units providing 24-hour services for people
with physical disabilities)
Sanction (always/sometimes)
House confinement
Ban on phone use
Ban on watching TV
Meal restrictions
Cancellation of home leave
Ban on computer use
Smoking ban / removal of tobacco products
Ban on drinking coffee
Ban on snacks
House/room arrest
Other
deduction of agreed amount from weekly allowance
being guided to one’s own room
Total
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Written house rules
Yes
No
0
3
0
0
0
0
1
1
0
3
1
0
1
2
1
2
0
0
0
2
2
6
0
12
Total
3
0
0
2
3
1
3
3
0
2
2
19
10
physical disabilities
Table 13. Measures used in care situations during the past year according to
whether the unit had prepared guidelines on the use of restrictive measures (units
providing 24-hour services for people with physical disabilities)
Guidelines on use of restrictive
measures
Used during the past year
Yes
No
total
Physical guidance
1
9
10
Physical restraint
1
4
5
Weighted blanket
1
1
2
Treatment shirt (restrictive clothing)
0
0
0
Safety helmet
0
0
0
Safety mat
0
0
0
Regular mat
0
1
1
Restraints
0
3
3
Sedatives
1
10
11
Locking doors
1
2
3
Diaper suit (restrictive clothing)
1
3
4
Restriction of freedom of movement
1
4
5
Restriction of contact
0
0
0
Confiscation of substances or objects
0
9
9
Bodily search
0
1
1
Withholding of property and deliveries
0
1
1
Inspection of client’s room
1
7
8
Special care
0
5
5
Drug testing
0
2
2
Breathalyser
0
4
4
Blood test
0
1
1
Isolation
1
1
2
Other
1
13
14
Total
1
23
24
Various kinds of restrictive measures were used at the units despite there being no
justification under law for this.
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Conclusions
ambiguity associated with the restrictive measures imposed on
social welfare clients and the grounds for such measures
- in part likely due to the lack of unequivocal legal provisions on
the restriction of the right of self-determination except in child
welfare
- The concepts and terminology related to restrictive measures is
also given different meaning in the different sectors, which has
resulted in units using practices which do not satisfy the
requirements imposed for restricting a basic right. There was
uncertainty i.a. in determining what constituted restriction and
what fell into the category of ordinary care
- that restrictive measures were also used as a form of
punishment for unwanted behaviour
- The importance of operating culture and leadership in the unit
=> Supervisory actions and guidelines by supervision authorities
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