National Alliance on Mental Illness
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What Are Restraints and Seclusion?
Restraints are human or mechanical actions that restrict freedom of movement or normal access to one’s body. Since the development of more effective psychotropic medications, emergency situations have become increasingly rare. In fact, some hospitals have moved to restraint-free policies.
Seclusion means any separation of the individual from the general population of the facility or institution to which the individual cannot return at will and includes a situation where the resident or patient is isolated behind a closed door or prevented by staff from leaving a room with an open door or threatened with loss of privileges for leaving the room or area.
In current practice, physical restraints are sometimes imposed on a patient involuntarily for control of the environment (curtailing individual behavior to avoid the necessity for adequate staffing or clinical interventions); coercion (forcing the patient to comply with the staff’s wishes); or punishment (staff punishing or penalizing patients). NAMI rejects these as legitimate reasons to impose restraints. See NAMI’s Position.
Background: A Clear Pattern of Abuse Exposed
In October 1998, The Hartford Courant published a five-part investigative series that revealed an alarming number of deaths resulting from the inappropriate use of physical restraints in psychiatric treatment facilities across the United States. A 50-state survey conducted by the newspaper documented at least 142 deaths in the past decade connected to the use of physical restraints or to the practice of seclusion. The report also suggested that the actual number of deaths is many times higher because many incidents go unreported. According to a separate statistical estimate commissioned by The Courant and conducted by the Harvard Center for Risk Analysis, between 50 and 150 restraint- or seclusion-related deaths occur every year across the country.
As a result of The Hartford Courant series and NAMI’s communications with its members, NAMI members have shared their horror stories of abuse and death. These are compiled in NAMI’s report, Cries of Anguish. More than 60 personal stories of incidents from 24 states and the District of Columbia were reported as of August 2000.