Patient choice: deciding between psychotropic medication and physical restraints in an emergency.

Y. Sheline and T. Nelson,
Bull. Amer. Acad. Psychiatry & the Law 21(3): 321-9, 1993.
The legal requirement to use least restrictive interventions in emergency psychiatric treatment does not stipulate whether physical restraints or medication is least restrictive. There is no current consensus about how to determine least restrictive interventions in a generalizable manner. In this study patients who were clients in a public psychiatric emergency service were anonymously surveyed and asked to state their preferences for specific interventions in a psychiatric emergency. In a choice between physical restraints versus psychotropic medication, 64 percent of clients preferred medication; 36 percent preferred seclusion or restraint. The rank order of preferred modality was 1) benzodiazepines--31 percent, 2) neuroleptics--26 percent, 3) seclusion--24 percent, 4) restraints--10 percent. The rank order of last choice was different. Patients preference is an important factor in determining the appropriate intervention in an emergency. Patient participation offers an opportunity reconcile to clinical and legal objectives, to i improve compliance, and to enhance patient and staff safety.