Quebec experienced its first psychiatric revolution in the early 1960s, marked by the Public Inquiry Commission on psychiatric hospitals ordered by the government of Jean Lesage. It is complex to measure the transformation of the psychiatric environment if one has never experienced it. Some fifty years after its deinstitutionalization, the fact remains that psychiatry continues to divide within its establishments. Particularly with regard to the use of chemical and physical restraint: advocacy groups for the defense of mental health rights have been campaigning for several years to promote other methods.
On May 15, the Collective for the Defense of Montérégie Rights organized a rally as part of the national day “No to control measures” in front of the Suroît hospital, in Valleyfield, which had recently been singled out for having abused control measures. In response to the slogan “Stop tying us up”, a hospital employee on a break on the sidewalk shouted at the group of demonstrators: “If you are being tied up, it is because you deserve it”.
“Pogne-tie-pike”
It is certainly not easy to become aware of the heaviness of such an intervention and the consequences it leaves, even less of the need to act to better supervise it. Over the past ten years, when I myself was hospitalized for my mental health, I witnessed several physical and chemical restraint procedures.
Then at university, I studied the history of madness, that of our psychiatric institutions and the struggles to limit control measures. Several patients have already told me that they never fully recovered. It’s true, we no longer see life the same way when we witness it.
The scenarios are similar, that of a nurse, for example, who works an obligatory overtime shift in a hospital that operates with a reduced staff. A patient on the floor is agitated, she offers him a medicine that could help him calm down. He refuses, turns in circles: he feels threatened and begins to speak loudly. The nurse has other patients to take care of, she can’t do everything. Since he is not cooperating despite her warnings, she decides to press the red button. An automated message resounds throughout the hospital: “code white in psychiatry”. Security agents arrive at the race, and the patient is quickly subdued on the ground. We prick him, we take him to isolation, we tie him up and we watch him as best we can, depending on the staff available.
Peer helper Luc Vigneault called this practice the PAP method: “pogne–attache–pique”. Over the past ten years, the Québec Ombudsman has had to intervene on several occasions regarding its problematic use. The reasons for the complaints it receives remain the same, year after year. For the period from 2000 to 2012, the coroner’s office indicates that the accidental deaths linked to the use of restraint occurred following “accidental strangulation and hanging”, the use of “dangerous material resulting in falls” and “suffocation”.
An ever fragile bond
Health personnel, based on a questionable definition of dangerousness, choose whether or not to apply control measures when they judge that their safety and that of others is at risk. There is no question here of making a detailed assessment of psychiatry since its deinstitutionalization. But we must be interested in this problem in spite of everything: a ravine remains between psychiatrists and patients.
Consulting is always a lottery, and schools of thought still coexist. There are psychiatrists who maintain a reciprocal link, where the patient is at the heart of his recovery. Then those who choose to keep a distance. They make diagnoses and, above all, they do not propose: they demand treatment. Otherwise, the file may be closed. They are not necessarily professionals who belong to another generation, simply an authoritarian tradition which is perpetuated.
This balance of power, which scientific literature always considers infantilizing and ineffective, reminds us of that of religious congregations when they administered asylums. We must obey, do not disturb, be conciliatory and, above all, do not grumble.
Limited solutions
The use of control measures is the Achilles’ heel of psychiatry. Several modifications have been made in the last sixty years in Quebec. Advocacy groups are calling for, among other things, a precise and restricted definition of dangerousness, noting in passing that it “has become an elastic concept, leading to an inadequate application of the law, even to an illegal application”.
Before getting to the point of tying up a person, health professionals are taught several techniques to calm the seizures. Do we insist that they be applied? It’s not the tools that they lack, it’s the involvement of the people present at the time of the crisis that requires a lot of effort.
Because each individual has their own values, they necessarily reflect their work. This is arguably where the line is drawn on good or bad decisions. Mandatory training and protocols exist, but the health system is imploding, time is running out and alternative measures are becoming too difficult to apply.
I’m no expert, I just experienced it. Society must continue this reflection that it had begun during the psychiatry revolution of 1960. No one deserves to experience psychiatric violence: the abuse of control measures represents the hidden face of the care of people living with mental health problems. of mental health. Physical and chemical restraints, if not rigorously applied, supervised and reviewed, can mortgage a person’s life. Solutions exist to overcome the problem. A real discussion involves talking about that side of madness that we would rather forget because at the heart of social inequality are cries that go unheard.