Do we stand by the values upon which the College was founded?

The association between the non-restraint movement and the formation of the Royal College of Psychiatrists has never been formally acknowledged in either current or past literature. This movement was a significant step in the humane treatment of patients within the psychiatric system and a focus point for the development of other forms of treatment for aggression and mental disorder.

The movement originated in York Asylum in the early 1800s, started by Pinel and Tuke, and was then taken up by Lincoln Asylum's lead physician, Edward Charlesworth. From 1828, also the time of Parliament attempts at passing legislation to improve monitoring of madhouses, Lincoln Asylum had gradually reduced the use of mechanical restraints, until their complete abolition in 1838. ¹ By 1839, interest had been generated, and Dr John Connolly visited from Hanwell Asylum in Middlesex. After witnessing Lincoln's progress, Connolly set about abolishing the use of mechanical restraints in Hanwell. ² By 1841, Lincoln was not the only asylum to abolish the use of restraints: Hanwell, Montrose and Northampton (now St Andrews Hospital) had joined the non-restraint movement. ³

In early 1841, Samuel Hitch, resident superintendent of the Gloucestershire General Lunatic Asylum, proposed the establishing of an association of ‘Medical Gentlemen connected with Lunatic Asylums’. ⁴ He sent a circular to 88 resident medical superintendents and visiting physicians in 44 asylums in June 1841, requesting their participation in his proposed association. The first annual meeting of the Association of Medical Officers of Asylums and Hospitals for the Insane took place on 4 November 1841, where it was announced: ‘The members here present have the greatest satisfaction in recording their appreciation of, and in proposing a vote of thanks to those gentlemen who are now engaged in endeavouring to abolish [mechanical restraint] in all cases.’ ⁴

This association later became the Royal College of Psychiatrists (1971) and this clear statement supporting the abolishment of the use of mechanical restraints heralded a new era.

The use of mechanical restraints remains current given the specific references in both the Mental Health Act Code of Practice and National Institute for Health and Clinical Excellence guidance, despite the extremely limited evidence base. It is helpful to be reminded that the College began with such benevolent principles: challenging the status quo and striving for the very best for our patients.