The future of care lies in abandoning restrictive measures
The Sant Joan de Déu Health Park in Sant Boi de Llobregat is the first mental health center in Spain to receive the Libera-Dignos accreditation , awarded by the Dignified Care Foundation . This accreditation certifies the almost negligible use of mechanical restraints in the center's acute and subacute psychiatric units. Specifically, in the subacute unit, no mechanical or chemical restraints have been used since 2019, and in the acute unit, the prevalence of restraints is less than 0.9% of cases treated.
Led by Dr. Ana Urrutia, the Dignified Care Foundation promotes a paradigm shift in care by fostering a new approach to care management that respects the dignity and rights of individuals, with a person-centered approach.
The Libera-Care Standard provides the rules to be followed to ensure the rigorous management of restrictive restraints and their eventual elimination within the implementing organization. Libera-Dignos accreditation is the highest level of implementation of the Standard.
This paradigm shift also reflects the preamble to the International Convention on the Rights of Persons with Disabilities . In it, the signatory states agreed to a series of principles such as respect for human dignity, autonomy and participation, respect for difference, the right to equal opportunities, and so on.
Listen to the users and their suffering
Those of us who care for people and manage care in mental health hospitalization resources advocate for the use of alternatives to avoid the use of any restrictive measures.
Those of us who have worked in this field for a long time feel that the care approaches we learned years ago are antithetical to our role of care and support. And those who have recently joined these services start from a vision and ethic of human suffering that simply does not consider the use of restrictive measures.
The number of people with mental health problems directly affected by these measures is growing, and they are better organized. They have raised their voices, and although I don't like to admit it, we healthcare professionals weren't the first to take them into account. Few people asked them how they felt about experiencing a restrictive measure firsthand, but some of us did.
As a mental health nurse, but even more so because of my personal value system, valid for life itself or for the care of others, being sensitive to others makes me better aware of their circumstances and therefore more influential in them.
I believe that knowledge is the fundamental basis for growth and change. It's essential to understand the other person's personal experience, even if it makes your ears ring, and also to possess academic knowledge that supports the professional's perspective at any given time. Perhaps previously there weren't many publications offering alternative care models, beyond innovative care experiences from many years ago and the gradual incorporation of new professional categories seeking meaningful engagement for the user.
Advance Care Planning in Mental Health
Progressively, the exchange of knowledge between professionals and institutions, but also the recognition of users and their suffering, has increased the fundamental theoretical and practical basis of what will constitute the future of mental health care.
Concepts such as de-escalation verbal intervention, environmental care, preventive and educational nursing care (including emotional self-management techniques and a dual approach to crises), shared therapeutic plans with the client, and many more, must be fundamental to improving nursing practice in mental health. Shared therapeutic plans, in particular, are crucial: ensuring the active participation of the client when the clinical situation allows, thus enabling us to anticipate potential future dysfunctions and conflicts through mutual agreement when stabilization is not achieved and a more directed, less collaborative approach is required.
Currently, many institutions are involved in this process of methodological change toward a person-centered approach focused on their experience. It is not easy, but the effort is worthwhile because of the improvements it brings to such important dimensions as dignity, humanity, and care for the individual. We cannot reconsider past approaches like restrictions as a first choice. Not even as an option.
Therefore, in conclusion, it will be crucial to continue listening to the voice and opinion of the service user, as they are the first-hand experts. Furthermore, it is essential to define the future of mental health policies and, on a smaller scale, care and treatment plans, in collaboration with the service user. This definition must incorporate all the legal and ethical reviews being conducted globally and locally, which simply aim to deepen the consideration of fundamental human rights, with or without a diagnosis. People first and foremost.
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