Applied mental health: Haircut dilemma

When a young woman who is a patient in a mental health ward refuses to have her matted and dirty hair cut, is restraint necessary?
Elaine is a 27-year-old woman who has a severe learning disability and who has a diagnosis of autism. Elaine is currently under the Mental Health Act. She was admitted for assessment following the breakdown of her community placement due to repeated aggressive incidents and concerns about her mental health. Since admission there has been no diagnosis of a mental health problem and her continuing behavioural difficulties have been attributed to her autistic spectrum disorder.
At the present time Elaine finds it difficult to tolerate any requests and demands placed on her. She finds any close contact from carers or other residents very difficult to tolerate and will barge at people with enough force to knock them off their feet, she is also known to throw any available object at others and will hit and kick out.
At the present time the staff team are adopting a low demand approach and ensuring that the environment Elaine is in is not too stimulating. For the main part Elaine chooses to be on her own and likes to wander in the large enclosed garden area.
In general, Elaine does not appear to enjoy any tactile contact with others. All personal care, washing dressing, oral hygiene etc has to be done with great care to avoid distress and problem behaviour. The amount of personal care Elaine receives is dictated by her reaction to the procedure. This often means that only the very basic hygiene is achieved. Elaines communication is limited both receptively and expressively. She only uses single words or very short sentences to ask for things and probably only has an understanding of what is said to her at a one word level. For the main part Elaine remains very tense and agitated although there are periods when she seems much happier and will sing songs which staff feel indicates that she is happy but they are unsure why.
A main concern at the present time is the condition of her hair which is heavily matted and tangled and has been described as resembling ‘upright dreadlocks’. Elaine does not seem bothered by her hair's condition. She often strokes her hands through her hair, this she often does with spittle on her hands. This behaviour adds to the problem with her hair hygiene. Staff suggest that this behaviour appears more of a habit or sensory behaviour rather than an indication that she likes her hair.
Staff report that Elaine will allow water to be put on her hair and that they attempt to use a ‘de-frizz’ shampoo but the client won’t allow them to massage this in. Staff have attempted to use conditioner to soften the hair and allow easier brushing or combing but the client will not tolerate this. They have also tried combing only a little bit at a time to reduce distress but this has met with no success. They have also tried using mild sedation and short duration physical intervention but the client became to distressed for them to continue.
Elaine’s mother, who still has close contact with her daughter, has expressed a wish for her daughter’s hair to be cut. Her mother feels that Elaine used to have nice hair and used to enjoy looking nice.
The staff and her mother are concerned that the condition of Elaine’s hair draws negative attention to herself. They are also concerned that there are possible health concerns such as head lice, psoriasis and alopecia although none of this is present at this time. However any attempt to cut her hair at the present time would probably require medication and physical restraint, which would cause distress to the client.