Most violence perpetrated by patients and inmates in psychiatric settings is the direct result of actions initiated by health care staff, including the use or threat of force, ridicule and humiliation, lack of respect for basic human needs and rights, and especially the failure to make a meaningful relationship with the individual. Before resorting to restraint, the staff should immediately examine the aggravating role of its own omissions or commissions, and especially focus on factors disrupting the relationship with the individual. Most violence in any setting is motivated by feelings of humiliation. To avoid the use of restraint, to create a therapeutic environment, and to maintain a high standard of ethics, all health care settings should aim at eliminating humiliation and encouraging respect. This requires empathic attention to the feeling and needs of clients or patients.
Patience is an antidote to the use of restraint.
In most cases, avoiding direct conflict or confrontation with an individual who is upset or angry will reduce the likelihood of an adverse outcome. Too much emphasis is placed on becoming skillful in the use of restraint. Much more emphasis should be placed on becoming skillful in the development of caring, respectful, empathic relationships during time of stress and conflict. All psychiatric and health facilities should conduct regular training programs on the handling of emotional crises or psychosocial emergencies through empathic, caring relationship and conflict resolution without the use of restraint. As a part of informed consent for potential patients, all health care organizations should be required to make public their rates of seclusion and restraint, and to compare them to regional or national averages.