Therapist Neurodiversity Collective

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Restraint and Seclusion are cruel, dehumanizing practices that result in life-altering trauma and poor mental health outcomes.
Restraint and seclusion are never therapeutic.


In their July 25, 2023 report, “Restrictive practices: A pathway to elimination,” The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Australia) determined that

  • Restrictive practices are at odds with international human rights obligations
  • Restrictive practices strip people with disability of dignity and have outcomes of trauma, pain, harm, and violation
  • Restrictive practice occur within an ecological system of violence, coercion and control

 

Though the Therapy Neurodiversity Collective understands that in critical emergencies, someone might need to be quickly and briefly restrained to keep themselves or others safe from harm, restraint has become part of an established routine in schools, residential homes, treatment centers, and medical settings. Restraint should never be used as a “behavior fixer.”

What do these organizations have to say about restraint and seclusion?

“Restraints and seclusion must only be used in emergency situations to ensure the physical safety of the child and all others and should never be used for purposes of discipline, retaliation and convenience. …The use of chemical restraints and mechanical restraints should be prohibited.” – Child Welfare League of America.
–  The Use of Restraints and Seclusion in Residential Care Facilities for Children

 

“Overuse and abuse of restraints and seclusion are symptoms of poor-quality care in facilities, poor state oversight, and misdirected public policy. State and federal agencies must take a greater role in assuring the safety and protection of children and adults who experience these interventions.”
National Mental Health Association Position Statement: The Use of Restraining Techniques and Seclusion For Persons with Mental or Emotional Disorders (NMHA Program Policy P-41)

 

The Federal Substance Abuse and Mental Health Services Administration (SAMHSA) issued a National Call to Action in 2003 concerning restraint and seclusion. “SAMHSA is committed to working with States, communities, consumers, families, providers, and provider organizations to ultimately eliminate the use of restraint and seclusion. Individuals with mental illness should not be confined, restrained, or retraumatized by the persons and resources put in place to help them.” 

Definitions:

Physical restraint immobilizes or reduces the ability of a person to move their torso, arms, legs, or head freely. 

Mechanical restraint is any mechanical apparatus, material, device, or equipment attached to or adjacent to a human body that restricts their freedom of movement and normal access to their own body. 

Chemical restraints include drugs that restrict the person’s ability to move or control their behavior which was not prescribed by a physical as a standard treatment for the person’s condition, and or that are not administered as prescribed (e.g., a much larger dose is given). The dangers of chemical restraint were documented by the Hartford Courant in 1989. (Jess Butler)

Seclusion is the involuntary confinement of a person alone in a room or area from which the person is physically prevented from leaving. 

 

Illustration by Kate Jones

Restraint or seclusion is often abused as a violent behavior management tool for noncompliance, perceived disrespect, bad language, property damage, and other minor behaviors that do not constitute imminent, serious, physical harm or bodily injury. Restraining someone can result in their death.

People have died while being restrained due to various reasons, including

  • Asphyxia: This is when someone can’t breathe. It can happen if they are held face down and someone puts too much weight on their neck, back, or stomach, or if items like blankets are put over their face.
  • Aspiration: This is when someone swallows things like spit while they’re held facing upwards.
  • Heart problems: These can be caused by too much physical effort, medicine conflicts, or unknown heart issues.”
Did you know?

Physical restraint has been associated with emotional harm, physical injury to staff and consumers, and has even resulted in death of individuals in care environments.
Various interventions have been implemented within care settings with the intention of reducing instances of restraint. One of the most common interventions is staff training that includes some physical intervention skills to support staff to manage crisis situations. Despite physical intervention training being used widely in care services, there is little evidence to support the effectiveness and application of physical interventions.

McDonnell, A. A., C., M., J., S., McAulliffe, H., & Deveau, R. (2023). Staff training in physical interventions: A literature review. Frontiers in Psychiatry, 14, 1129039. https://doi.org/10.3389/fpsyt.2023.1129039

Therapist Neurodiversity Collective is a proud affiliate of Alliance Against Seclusion and Restraint and aligns with their core beliefs and mission:

  • We believe in the reduction and elimination of the use of physical restraint and seclusion wherever they occur.
  • We believe in ending the use of corporal punishment in schools and homes across the world.
  • We do not support compliance-based approaches to behavioral management, such as behaviorism.
  • We support trauma-informed, neuroscience-aligned, relationship-driven, and collaborative approaches.