A second incident, in which a patient smashed a glass ashtray against a wall and chased him down the corridor, exacerbated his stress.
Today, years later, he acknowledged the assault and the subsequent reflection provided him with a different frame of reference as to how mentally-ill patients viewed the use of restraints in their treatment and whether, in their eyes, this constituted unprovoked violence.
Together with Sarah Rae, he created Promise, a proactive care initiative aimed at seeking out and embracing new ideas and, in the interests of patient-centred care, working to develop compassionate and creative alternatives for care of patients with mental illness.
This came against a background of 2013 research, which found huge variations in the use of restraint across England, with one centre reporting 38 incidents and another more than 3,000. There were also concerns about the face-down, or prone restraint method, plus related injuries, which numbered more than 1,000 in a single year.
Kar Ray, also a consultant psychiatrist at Fulbourn Hospital in Cambridge, in the UK, pointed out that the use of mechanical constraints was commonplace in Europe and the developing world, and that he was sure “we can do better than this”.
“Our vision for Promise is to promote dignity by eliminating coercion in mental health.
“We need to have the courage to challenge the status quo, and not accept that because things have been this way for a long time, we should carry on this way,” he told delegates at the World Psychiatric Association Conference in Cape Town this week.
They had started with five founding members, and were now 30 strong, and were constantly attracting more people keen on sharing and celebrating good practice.
For caregivers, Kar Ray stressed that Promise’s message was clear: “We must contain the situation to keep patients and caregivers safe. But every time we lay hands on a patient is an opportunity for us to think whether there was something better we could have done upstream, ahead of the situation developing.
“If we can enhance the patient experience, maybe those situations don’t necessarily have to happen in the first place,” he said.
“Perhaps it’s not a necessary evil. Perhaps we are just stuck in the limitations of the past. And perhaps we need to shift out of that mindset, into a future full of possibilities,” he said.
