Pipeline Feature
Seclusion and Restraint
By Randy Tucker
Seclusion (isolating a person from human contact) and restraint
(using physical devices to immobilize a person or using
medications to subdue or incapacitate an individual) are still
often used in public or private “Mental Health Treatment” facilities,
according to attendees and participants at the recent
“Seclusion and Restraint Public Forum”, sponsored by the
Georgia Advocacy Office and the PAIMI Advisory Council.
Several consumers of mental health services offered personal
stories of their experiences relating to these practices. No one
said that he or she was helped by the practices. Universal impressions
were of fear, pain, depersonalization and disrespect
of individuality. Some told of staff that deliberately provoked
restraint situations. It is no surprise that they were not consulted
about their needs during the “interventions” nor given
the opportunity to be understood.
Particularly disturbing were stories about individuals having to
help restrain other individuals, persons with claustrophobia
being secluded as punishment, restraints being tightened to the
point of physical pain if they angered staff, daily restraints and
lengthy restraints of up to seven hours without the dignity of
being provided bathroom services. Consumers told of feeling
fear, anger, humiliation and distrust which prevented them
from seeking needed Mental Health services in the future.
Most felt that a kind word and someone who would listen to
them would have been much more effective.
Almost two years ago I attended a national conference sponsored
by SAMHSA and CMHS titled “Eliminating Seclusion
and Restraint in Mental Health Systems.” I learned that Hawaii
and New Hampshire had actually eliminated the practices
(not just reduced them) in their facilities. I had witnessed first-
hand the effective elimination of restraints and seclusion earlier
in an Adolescent Treatment Facility where I worked almost thirty
years ago, and often suspected it could be done on a larger scale.
Seclusion and Restraint are poor substitutes for caring treatment.
These practices often repeat traumas for individuals with Mental
Illness, particularly those who have been abused. They are often
demeaning and always non-empowering. Increased fear and
distrust do not lead to effective treatment. The “control” afforded,
though expedient, limits treatment options. It creates
“us/them” situations, and greatly reduces effective communication.
Seclusion and restraint offer no solutions for more effective
coping skills, and give consumers no opportunity for helping
determine what works for them.
Supporters of the practices defend their actions by citing staff
and patient safety. Personnel may feel more secure knowing that
they have the upper hand and cannot be challenged by those they
are hired to serve. Fear is a way of increasing control and compliance.
I remember people asking “how can we treat them if
they are not compliant,” to justify overmedication (chemical restraint).
Seclusion was reframed as a way of “limiting stimulation”.
Indeed, it seems more expensive to take the time to talk
with, understand and monitor individuals than to restrain them.
But if the treatment is less effective, or consumers are less trustful
and avoid needed treatment later, it will be more expensive in
the long run.
I think it would be helpful if records are kept for every seclusion
or restraint in all private and public facilities, and that these records
be systematically reviewed with the goal of reducing seclusion
and restraint throughout the state. You can help by writing
to PAIMI and putting a personal face on the problem. Submit
your stories directly to the Georgia Advocacy Office, One Decatur
Town Center, 150 Ponce de Leon Ave., Suite 430, Decatur,
GA, 30030.
