There is little evidence to suggest that restraints or seclusion have any therapeutic or long-term value, and the potential for emotional and physical harm is great. Furthermore, it would seem that there is a great deal of data to suggest that reliance on emergency interventions such as these sometimes leads treaters to ignore the preventative strategies that could be utilized to head off a crisis well in advance.
Perhaps most disturbing in regards to restraint specifically is that the implication that staff have the right to put their hands on someone whom they are responsible for treating clearly leads to the degradation of the individual and his or her rights, and sometimes cavalier attitudes about when and how restraint should be used. At least one member of SSN has heard hospital staff refer to putting a patient in restraints as �taking �em down.� The coldness, casualness and lack of humanity that this conveys to us as fellow staff is surely also communicated to the individuals experiencing this event.
Clearly, in order to insure a transformation of the mental health system into one that prioritizes human rights, dignity and personal choice, and to encourage those who do need to help to seek and successfully obtain the help they need, restraint and seclusion protocols simply must be changed.
We at SSN would also like to include a link to a memorandum from Elizabeth Childs, the Massachusetts Commissioner of Mental Health, stating her own intentions to move towards the elimination of restraint and seclusion.
FAQ
1. Do you really believe that there is no situation that will ever merit restraint?
Realistically speaking, we believe that there may be very rare situations where restraint must be used to prevent serious injury to staff or the individual in question. However, it is just as true that there are hospitals and facilities who use restraint frequently and those who don't, and it is not because the latter is working with significantly more challenging individuals than the former. We believe that one of the primary differences between the two types of facilities is whether or not they regard restraint as a true option. Where it is considered a true option, individuals will inevitably find that it must be used more often than in places where it is not seen that way.
2. In the event that a restraint occurs, what steps should be taken?
We advise that agencies and institutions eliminate restraint and seclusion as options within their facilities. In the event that a restraint does occur, we recommend that a mandatory investigation automatically be started which regards at least the following questions:
A. What signs were there that this individual was having difficulty during the week prior?
B. Were any concerns or unusual behavior documented in log notes during the week prior?
C. Who was notified of any increased concerns during the week prior?
D. What preventative steps did staff take to avoid this situation in the week prior?
E. What were the details of the incident leading up to the restraint?
F. What kind of restraint was used & what injuries resulted to the individual and/or staff?
G. What could have been done differently?
We also believe that interviews of both the staff involved in the restraint and the individual who was restrained are critical to this process.
