This document discusses restraint options for mentally ill patients, including immediate restraint during admission to a psychiatric hospital, chemical restraint using sedative drugs, and physical restraint of limbs. Chemical restraint aims to rapidly sedate agitated patients using benzodiazepines, droperidol, or ketamine administered intravenously or intramuscularly while closely monitoring vital signs. Physical restraints are usually combined with chemical sedation and require trained staff to securely restrain large joints in a supine position until the patient is calm. Restraints should be removed as soon as possible once the patient is sedated.

1. RESTRAINTS OF MENTALLY ILL
PERSON
Department of forensic medicine
intern

2. • DEFINITION:any method or device that restricts freedom of
movements,physical activity.
• Why do we restrain patients?
• To prevent harm to the patients or others
• To assist in assessing and managing the patient.
• Restraints should never be
used for ease of convenience.

3. RESTRAINTS MAY BE
•IMMEDIATE :
•ADMISSION IN PSYCHIATRIC HOSPITAL.
IMMEDIATE RESTRAINT: it is done in case of
a. Mentally ill person who is dangerous to himself or others
b. Person suffering from delirium due to disease
c. Delirium tremens.
ADMISSION IN PSYCHIATRIC HOSPITAL:
a. ADMISSION ON VOLUNTARY BASIS:
patient may request medical officer-in-charge of psychiatric
hosptal for admission and treatment.
b.ADMISSION UNDER SPECIAL CIRCUMSTANCES:
Application is made by relative or friends.application should be
accompanied by two medical certificate

4. d.RECEPTION ORDER ON PRODUCTION OF MENTALLY ILL
PERSON BEFORE MAGISTRATE:
Officer in charge of police station is authorised to arrest
dangerous mentally ill person
e. ADMISSION AFTER JUDICIAL INQUISITION:
if person possesing property is alleged to be mentally ill
,the district court may order an inquisition upon
application made by relative
c.RECEPTION ORDER ON APPLIATION:
I. Officer in charge of psychaitric hospital can make
an application to the magistrate .
II. Relative can make application in prescribed form
to the magistrate.

5. f.ADMISSION OF MENTALLY ILL PRISIONER :
Prisioner can be admitted into any psychiatric hospital by an
order passed by an apprpriate authority under prisioner act
1900.
g.ADMISSION OF ESCAPED MENTALLY ILL PERSON:
They can be retaken by any police officer and re admitted.
WHAT ARE THE RESTRAINT OPTIONS?
1. VERBAL DE-ESCALATION
2. CHEMICAL RESTRAINT
3. PHYSICAL RESTRAINT

6. CHEMICAL RESTRAINT:
• Drug is considered restrain when used as a restiction to
manage the patients behavior or freedom of movement.
• Goal is to rapidly and safely sedate the patient
 Consider the factor that affect dose and dose interval that is
- Level of agitation
- body size
- Age
- Medical history
- Previous response to sedative drugs
• Choose route of admission
I.V route more rapid more
predictable easily titrable

7. •Choose agent and dose:
Benzodiazepines
Neuroleptics :
Droperidol –i.v or i.m –dose 2.5-5mg i.v and 5-10 mg i.m
risperidone-0.5-2mg per oral or sublingual –works
well in elderly.
KETAMINES:
Dissociative anaesthetic agent –good backup option in case of
extreme benzo tolerance.
COMPLICATIONS :
 Over sedation
Hypotension
Acute dystonia
Delirium
Tolerance.

8. POST SEDATIVE CARE
Pulse and respiratory rate
Oxygen saturation
ECG
BP check
Close monitoring of conscious state and airway adequacy
Temperature control
POST SEDATIVE CARE DOCUMENTATION
 reason for restraints
Alternative therapies attempted
Assessment of potential injuries
and any complication of restraints
Ongoing sedation options
Discussion with psychiatry team

9. PHYSICAL RESTRAINTS
•Usually combined with chemical restraints
•Secure large joints
•Medical instability is a contraindication
•Requires trained staff
INITIATE MANUAL RESTRAINT
•One person for each limb
•One person control the head
•One person to administer pre prepared medicines
•Supine position

10. VARIOUS METHODS
For limb :
•Cloth
•Non locking leather
Mittens
Tabletop chair
REMOVAL OF RESTRAINTS
•As soon as possible
•Once patient is calm or sedated
•Remove restraints one by one

11. THE END