Medical personnel can use direct coercion only under very specific circumstances. Each case (detention, immobilisation, isolation and forced use of medications) must be noted in the medical records.
The Act on Mental Health Protection defines restraint as short-term immobilisation with the use of physical force, forced use of medications - as an emergency or planned administration of medications into the body without the person’s consent, immobilisation - as incapacitation, e.g. using belts or a straitjacket, and isolation - as placement in a closed and properly adapted room, in which the person stays alone.
Only when justified
Direct coercion may be used in a psychiatric hospital or a social welfare home, and when a person, due to a mental disorder, threatens his/her own life or is unable to meet the basic necessities of life and must be transported to the hospital.
Coercion against people with mental disorders can be used, i.a., when they pose a threat to the life or health of their own or another person, or against public safety. Its use is also permitted when such a person violently destroys objects in their surrounding, or seriously disrupts the functioning of an institution.
The decision on whether to use coercion is made by the physician. The physician determines the type of coercion and personally supervises whether and how it is enforced. If it is not possible to obtain an immediate physician’s decision, a nurse or paramedics may decide to use coercion. The nurse is obliged to inform the doctor about that, and paramedics have the obligation to inform the medical dispatcher.
The person upon whom coercion is to be used must be warned of such possibility.
According to the Regulation of the Minister of Health on the manner of using and documenting the use of direct coercion and assessing the appropriateness of its use, coercion can last only as long as there is reason to use it. Immobilisation or isolation cannot last longer than four hours (in social welfare homes - eight hours). The doctor, after a personal examination, may extend these measures so that they last further two six-hour periods. Any further extension is possible after obtaining a psychiatrist’s opinion, and after 24 hours the doctor in charge of the unit should be notified.
Coercion under supervision
The nurse has a duty to check the physical condition of the immobilised or isolated person at least once every quarter. Information about the condition of the person is promptly recorded by the nurse in the so-called immobilisation or isolation card.
Each case of coercion or a warning about the possibility of using coercion is to be noted in the medical records.
In the case of persons admitted to a psychiatric hospital without their consent, direct coercion can also be used when it is necessary to perform the required therapeutic functions.
Other circumstances under which coercion may be used are associated with the exercise of court order regarding the referral of a person with a mental disorder to a social welfare home or a mental hospital. If the person against whom such an order has been issued refuses to appear before these institutions, or otherwise impedes the execution of the order, the court may warrant his/her detention and compulsory appearance. It takes place in the presence of a doctor, nurse or a team of paramedics.
The facility manager or a psychiatrist authorized by the Marshal of the voivodeship assesses the legitimacy of the use of coercion within three days.
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