Coronavirus disease 2019 (COVID-19) is an infectious disease that has caused a global pandemic due to its serious health consequences and high mortality rate [1]. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in Spain, the evolution and consequences have been significantly more severe compared to other countries, especially during the first wave of the pandemic [2, 3]. The restrictive measures implemented by the Spanish government at the beginning of the pandemic (approving the state of alarm on March 14, 2020, which ended on June 21, 2020) were among the most restrictive around the world, prohibiting all non-essential activities outside the home [4]. Subsequently, national measures have been combined (for example, the obligation to wear a mask, even outdoors) with different measures, depending on the autonomous communities that have varied, based on the incidence of the virus in the last 14 days [5].
Inpatient mental health wards have had to adapt to the pandemic. Protection measures against the disease are difficult to implement in hospitalization wards (for example, social distancing) since users are admitted to open spaces and it is difficult to apply the measures in people with psychotic and manic symptoms, among others [6]. Additionally, agitation and aggressive behaviors could represent a challenge in following prevention and social distancing measures. This has led to the use of different measures to avoid contagion; for example, family visit restrictions, restriction of conditions for admission, previous isolation, conduction of tests, educational interventions, and mobility restrictions [7–12]. These measures have led to a reduction in the availability of care that could have significant long-term consequences [13, 14]; however, an increase in the number of admissions has also been reported [9].
The pandemic has also caused changes in the internal organization of inpatient wards, making it difficult to implement some treatments, such as group treatments and interactions with professionals [6]. It is still unknown how these operational changes and the implementation of new security measures have affected the use of coercive measures, such as mechanical restraint. In fact, mechanical restraint, by definition, implies direct contact with professionals, can carry a risk of infection and could be experienced even more traumatically by users [15].