A wicked problem: Chemical restraint: towards a definition

There is ongoing international emphasis to reduce the use of all coercive practices in the care of people with a mental illness using de-escalation techniques as the first line intervention (National Institute for Health and
Care Excellence 2015). Coercive practices include seclusion, physical, mechanical, and chemical restraint. The rationale for the use of restraint is that it is only to be used as a last resort, when the safety of the person and others outweighs the risk of restraining the person and that medication and treatment are immediately provided. There is a large and growing body of research literature on the practice of various forms of coercive practices (Beysard et al . 2018, Bowers 2015; Duxbury 2019; Gerace et al. 2014, Gerace and Muir-
Cochrane 2018) Brophy et al. (2016) also report on emotional restraint experienced by consumers when they feel constrained from expressing their views or needs as inpatients or in the community. There is also an expanding body of work on the use and evaluationn of least restrictive initiatives such as ResTRAIN and Safewards, evidenced-based approaches promoting per-
son-centred care without coercion wherever possible (Bowers 2015; Mann-Poll et al. 2020)