Number of patients physically restrained at psychiatric hospitals soars

The number of patients physically restrained at psychiatric hospitals more than doubled to 10,299 in fiscal 2013, compared with a decade earlier, data released Monday by the Health, Labor and Welfare Ministry show.

In addition to physical restraint, which often involves lashing a patient’s arms and legs to a bed using special belts, the number of patients who were locked alone in a room increased by about 30 percent to 9,883 in the year ending March 2014.

The sharp rise in the use of physical restraint is partly attributable to the growing number of patients suffering from Alzheimer’s disease, but a clear correlation cannot be identified, the ministry said.

The use of physical restraints at psychiatric hospitals in the country is permitted by law only when designated doctors determine that patients could harm themselves or others, but experts say such decisions should be made through a third-party organization, since using unnecessary body restraints is thought to damage personal dignity and infringe on human rights.

Miyuki Yamamoto, deputy head of an Osaka-based nonprofit group for the human rights of mental patients, said the number of physically restrained patients is “abnormally high,” reflecting indiscriminate use among some young doctors.

“The act of physical restraint deprives people of their human dignity,” Yamamoto said.

The group has found some cases where doctors had prepared to isolate and physically restrain patients even before they were taken to hospitals in emergencies.

Yamamoto said the state should look into the reasons for such widespread use of body restraints and investigate institutions with a high number of such occurrences.

A system where a third-party organization can determine the appropriateness of physical restraints should also be created, she said.

Fumihiro Yoshihama, a professor of psychiatric nursing at Bukkyo University, pointed out that some medical workers tie down or isolate patients to prioritize their safety at night when fewer workers are present.

Yoshihama said there may be an attitude at hospitals that the use of physical restraints cannot be helped because some people with dementia do not understand explanations about treatment and some are uncooperative.

“But this should not happen and hospitals need to understand that physical restraint should only be a temporary measure,” he said.

It is necessary to increase the number of staff, especially at night, he said, adding that standards regarding the circumstances under which restraints can be used should be spelled out more clearly.

The health ministry conducts a nationwide survey on psychiatric hospitals every year, which includes the number of admitted patients, medical staff and beds. In fiscal 2013 the survey covered 1,616 facilities.

The figure on the physical restraint of patients has been rising steadily after appearing at 5,109 in fiscal 2003, when a question about it was first included in the survey. The number of patients confined to a locked room was at 7,741 in the year.

Meanwhile, the number of patients at psychiatric hospitals dropped to about 297,000 in fiscal 2013 from around 329,000 in fiscal 2003.