The Bazelon Center opposes the use of seclusion and restraint in all but the most extreme instances where there are serious and immediate threats to physical safety and health. They should be used only in settings that are prepared to address the inherent physical and psychological risks involved.
Seclusion involves confining a person in a room or other designated area. Restraint employs a mechanical device (such as leather straps or a vest restraint) or physical force to restrict movement. Sometimes drugs are used in a way that renders them chemical restraints rather than treatment interventions. At one time, use of these measures was routine in mental health settings. As a consequence of reform efforts during the last several years, there have been dramatic reductions in the use of seclusion and restraint and a growing number of psychiatric hospitals have become essentially seclusion- and restraint-free.
Seclusion and restraint are safety measures, not treatment, and they should never be part of standard treatment for someone’s condition. Their use—particularly when it is recurrent or protracted-- represents a treatment failure and should be addressed as such. Federal regulations and standards by accrediting bodies prohibit the use of seclusion and restraint in healthcare settings as punishment or to compensate for staffing shortages. The 1987 Nursing Home Reform Act included specific measures to limit and reduce the use of restraints in nursing homes.
Seclusion and restraint can lead to death, serious physical injury, and trauma. People subject to seclusion and restraint experience it as frightening, humiliating and dehumanizing. These are last-resort measures that should only be used if other less-intrusive options have failed or are not available. People subject to seclusion and restraint require very careful one-to-one monitoring. They should be released from seclusion or restraint as soon as the immediate physical danger is diminished and they should participate in a post-event debriefing with professional staff to better understand what occurred and how to prevent recurrence.
The Bazelon Center is working to limit seclusion and restraint not only in hospitals, but also in residential treatment settings, juvenile detention centers, and schools. The Bazelon Center advocates for service systems that rely on collaboration rather than control to achieve safety. Respectful and empowering of consumers, they use a range of effective strategies, including crisis plans and advance directives, to achieve safety and minimize coercive interventions like seclusion and restraint.
Both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Association of State Mental Health Program Directors (NASMHPD) have called for the reduction and elimination of coercive practices such as seclusion and restraint. (See the SAMHSA Roadmap to Seclusion and Restraint Free Mental Health Services and the NASMHPD Position Statement on Seclusion and Restraint.)
Until the use of seclusion and restraint is eliminated, any use must comply with strict procedural safeguards and be consistent with standards published by the Joint Commission and, for health care providers that receive Medicare and Medicaid, the Center for Medicare and Medicaid Services rules.
Based on lessons learned from seclusion and restraint reforms, the Bazelon Center has launched an initiative aimed at reducing or eliminating what should be considered another instance of system failure, the routine involvement of police with people who have serious mental illness. See the Performance Improvement Project page for more information.