Yes and no.

There is guidance, for example, from the Brazilian Society of Geriatrics and Gerontology, in partnership with ‘Choosing Wisely’, which states that people should not be mechanically contained/restrained (SBGG, 2018). However, this is not prohibitive and still is common practice in Brazil. Mostly, the guidance available says restrains (chemical/physical/environmental) should be avoided and should be done only as a last resource to a) protect the person, b) protect others, c) guarantee effective treatment. This decision should be discussed among the multidisciplinary team and with the family, and the reasons for that should be documented.

References:

SBGG. (2018, June 7). CBGG 2018: SBGG divulga recomendações sobre escolhas sensatas em saúde em parceria com Choosing Wisely Brasil. SBGG. https://sbgg.org.br/cbgg-2018-sbgg-divulga-recomendacoes-sobre-escolhas-sensatas-em-saude-em-parceria-com-choosing-wisely-brasil/

There is universal law on monitoring the use of coercive practices in mental health care and elderly care. The Mental Health Ordinance (Cap. 136) regulates the conditions and circumstances under which mechanical means of restraint or seclusion may be applied to patients (Department of Justice, 2019b). The Residential Care Homes (Elderly Persons) Regulation (Cap. 459A) requires the home manager to maintain records of any action taken, including the use of force or mechanical restraint, to prevent or restrain a resident from injuring himself or others, damaging property, or creating a disturbance (Department of Justice, 2020).

References:

Department of Justice. (2019b). Cap. 136 Mental Health Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap136.

Department of Justice. (2020). Cap. 459A RESIDENTIAL CARE HOMES (ELDERLY PERSONS) REGULATION. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap459A.

This section to be updated soon.

There is no specific regulation regarding coercive practices targeted at people with dementia. However, stigma in mental illnesses often results through physical restraining of people living with mental illness, especially in areas where healthcare can be difficult to access. The practice is known as pasung (shackling) and can still be found in Indonesia despite being banned since 1977 (Human Rights Watch, 2016). In 2017, the Ministry of Health has issued a regulation which covers the prevention of the practice as well as management and rehabilitation guidelines for people affected by these practices. Management of ending of the practice is approached not only through advocacy and education, but also by making pharmacological and non-pharmacological interventions accessible. This is done by facilitating the registration of people affected with the NHIS as well as through home visits and home care, day care and vocational rehabilitation (Permenkes No. 54/2017 Tentang Penanggulangan Pemasungan Pada Orang Dengan Gangguan Jiwa (Ministry of Health Regulation No. 54/2017 on Countermeasures of Shackling Practice on People with Mental Illness), 2017).

References:

Human Rights Watch. (2016). Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia. Human Rights Watch.

Permenkes No. 54/2017 tentang Penanggulangan Pemasungan pada Orang dengan Gangguan Jiwa (Ministry of Health regulation No. 54/2017 on Countermeasures of Shackling Practice on People with Mental Illness). (2017). (Testimony of Ministry of Health Republic of Indonesia).

According to the Ministry of Health, Strategic Business Plan (2015-2018), Jamaica has established protocols for the use of restraints and seclusion for general and mental health workers.

References:

Government of Jamaica, Ministry of Health. (2014). Strategic Business plan 2015-2018. Available from: https://moh.gov.jm/wp-content/uploads/2015/07/Ministry-of-Healths-Strategic-Business-Plan-2015-2018.pdf

Kenya still relies on the Convention on the Rights of Persons with Disabilities (CRPD). Article 16: Freedom from exploitation, violence, and abuse states that “in order to prevent the occurrence of all forms of exploitation, violence, and abuse, States Parties shall ensure that all facilities and programmes designed to serve persons with disabilities are effectively monitored by independent authorities” (United Nations, 2006), page 12.

References:

United Nations. (2006). Convention on the Rights of Persons with Disabilities and Optional Protocol. https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf

The Official Mexican Standard 025 (DOF, 2015) for the Provision of Services in Psychiatric Medical Hospital Care Units, indicates a set of Provisions that regulate the treatment and rehabilitation of people with a mental disorder, respecting their human rights and covering two areas: a) Quality specialised medical care, and b) Preservation of the human rights of the user. With respect to this second item, it is stated that people with mental disorders have the right to receive dignified and humane treatment by mental health personnel, they are not to be discriminated against because of their condition, not to be the object of diagnosis or treatment for political, social, racial, religious or other reasons different from or external to the state of their health, they have to be protected against all exploitation, abuse or degrading treatment, and they are not to be subjected to physical restrictions or involuntary confinement.

References:

DOF. (2015). Norma Oficial Mexicana NOM-025-SSA2-2014. Para la prestación de servicios de salud en unidades de atención integral hospitalaria médico-psiquiátrica. http://www.dof.gob.mx/normasOficiales/5805/salud3a11_C/salud3a11_C.html

Yes. In line with international obligations as a signatory to the UN convention of rights of persons with disabilities (UNCRPD) and the UN convention against torture (UNCAT), New Zealand’s Health and disability services (Restraint Minimisation and safe practice) Standards were released in 2008 (Standards New Zealand, n.d.).

References:

Standards New Zealand. (n.d.). Health care services standards. Ministry of Business, Innovation & Employment. Available from: https://www.standards.govt.nz/sponsored-standards/health-care-services-standards/.

South Africa has “Policy guidelines on seclusion and restraint of health care users” that guide practitioners on the use of these methods to contain only severely disturbed behaviours (i.e., where other techniques have failed) that are likely to cause harm to the self and others, including property (for more detail, see DOH, 2012).

References:

DOH. (2012). Policy Guidelines on Seclusion and Restraint of Mental Health Care users. Available from: https://www.knowledgehub.org.za/system/files/elibdownloads/2019-07/Policy%2520guidelines%2520on%2520seclusion%2520and%2520restraint%2520of%2520mental%2520health%2520care%2520users%25202012.pdf