Seclusion and Restraint in Mental Health Units
Seclusion and restraint have long been controversial practices within mental health units, sparking ethical debates and concerns over their potential harm to both patients and staff. Seclusion involves isolating a patient in a designated room, while restraint refers to the physical, mechanical, or chemical restriction of a patient’s movement or behavior. These interventions are typically employed as last resort measures when a patient exhibits severely disruptive, aggressive, or self-injurious behavior that poses a threat to their own safety or that of others.
Despite their intended purpose of maintaining safety and order within these facilities, there is a growing recognition of the need to minimize the use of seclusion and restraint. This shift stems from a deeper understanding of the potential trauma and long-lasting psychological impacts these practices can inflict on already vulnerable individuals. Furthermore, the physical and emotional toll on mental health staff tasked with implementing such interventions has also come into sharper focus, highlighting the urgency for safer, more humane alternatives.
What are Seclusion and Restraint?
Physical Restraint
Mechanical Restraint
Mechanical Restraint utilizes devices such as restraint belts, wrist and ankle cuffs, or restraint chairs to restrict a patient’s movement. These methods are typically used when physical restraint alone is insufficient or when prolonged restraint is necessary.
Chemical Restraint
Chemical Restraint involves administering sedative or antipsychotic medications to subdue or calm an agitated patient. This type of restraint is used when other methods are ineffective or pose a significant risk to the patient or staff.
Seclusion and restraint are generally employed as last-resort interventions when a patient’s behavior escalates to a point where they pose an imminent risk of harm and less restrictive de-escalation techniques have been unsuccessful. These interventions are intended to be temporary measures to ensure the safety of the patient, staff, and others until the patient can regain control of their behavior.
Impact on Patients
The use of seclusion and restraint in mental health settings can have severe and long-lasting negative impacts on patients. From a psychological perspective, these interventions can be deeply traumatizing and re-traumatizing, triggering feelings of powerlessness, fear, and a loss of autonomy. Patients may experience increased anxiety, depression, and post-traumatic stress symptoms as a result. A systematic review found that the incidence of post-traumatic stress disorder after seclusion and restraint interventions ranges from 25% to 47%, which is considered significant, especially for patients with past traumatic experiences
Seclusion and restraint can also have physical consequences for patients. Restraints, particularly physical and mechanical restraints, carry risks of injury, including bruising, cuts, and even fractures or asphyxiation in extreme cases. Patients in seclusion rooms may engage in self-injurious behaviors or experience dehydration, malnutrition, and other physiological effects of isolation.
Furthermore, these practices can undermine the therapeutic relationship between patients and staff, eroding trust and hindering the healing process. Patients may feel dehumanized, disrespected, and unsafe in an environment meant for their care and recovery.
The trauma inflicted by seclusion and restraint can have lasting impacts on a patient’s mental health journey. It may exacerbate existing conditions, create new psychological distress, and make individuals more hesitant to seek help in the future. In severe cases, the experience can lead to worsening symptoms, longer hospital stays, and setbacks in the recovery process.
Impact on Mental Health Staff
The use of seclusion and restraint in mental health units takes a significant emotional and physical toll on staff members. Implementing these interventions is often a high-stress and traumatic experience, leading to burnout, moral distress, and safety risks.
Burnout is a common issue among mental health staff, as they frequently face challenging and emotionally demanding situations. The act of restraining or secluding a patient can be particularly draining, both physically and mentally. It can leave staff feeling exhausted, overwhelmed, and detached from their work.
Moreover, the use of seclusion and restraint can cause moral distress for staff members who may feel conflicted about these practices. Many healthcare professionals enter the field with the intention of providing compassionate care and promoting healing. However, the implementation of seclusion and restraint can contradict these values, leading to feelings of guilt, shame, and ethical dilemmas.
In addition to the emotional toll, there are significant safety risks associated with the use of seclusion and restraint. Staff members may sustain injuries during physical interventions, such as bites, scratches, or blunt force trauma. There is also a risk of psychological trauma, particularly if a patient becomes severely distressed or if the intervention goes awry.
Overall, the impact of seclusion and restraint on mental health staff is substantial, contributing to high levels of stress, burnout, and moral distress. It is crucial for healthcare facilities to prioritize the well-being of their staff and explore alternative approaches that promote a safer and more therapeutic environment for both patients and staff members.
Trauma-Informed Care
Trauma-informed care is an approach that recognizes the widespread impact of trauma and aims to create an environment that promotes healing and avoids re-traumatization. In mental health settings, this means prioritizing the physical and emotional safety of patients and creating a culture of trust, transparency, and collaboration.
A key principle of trauma-informed care is understanding that many individuals seeking mental health services have experienced trauma in their lives, whether it’s abuse, neglect, violence, or other adverse experiences. These traumatic events can have long-lasting effects on a person’s mental and physical health, as well as their ability to cope with stress and form healthy relationships.
By adopting a trauma-informed approach, mental health professionals can better understand the unique needs and perspectives of their patients and tailor their care accordingly. This involves creating a safe and welcoming environment, building trust and rapport with patients, and empowering them to have a voice in their treatment plan.
Trauma-informed care also emphasizes the importance of staff training and education. Mental health professionals must be equipped with the knowledge and skills to recognize the signs of trauma, respond appropriately, and provide trauma-specific interventions when necessary.
Ultimately, the goal of trauma-informed care is to create a therapeutic environment that promotes healing and recovery, while minimizing the risk of re-traumatization. By prioritizing patient well-being and safety, mental health facilities can reduce the need for coercive interventions like seclusion and restraint, and instead foster a culture of compassion, empowerment, and respect.
The Role of Behavioral Emergency Response Teams (BERT)
Behavioral Emergency Response Teams (BERT) reduce the need for seclusion and restraint in mental health units. These specialized teams are specifically trained to respond to crisis situations and de-escalate them before they escalate to a point where seclusion or restraint becomes necessary.
BERT members receive extensive training in crisis intervention, de-escalation techniques, and trauma-informed care. They learn to recognize early warning signs of distress or agitation in patients and employ various strategies to defuse tense situations. These strategies may include active listening, empathetic communication, and creating a safe and supportive environment for the patient to express their concerns.
When a crisis situation arises, the BERT team is dispatched to assess the situation and intervene promptly. Their primary goal is to establish a therapeutic rapport with the patient, understand the underlying causes of their distress, and work collaboratively to find a resolution that addresses their needs without resorting to seclusion or restraint.
BERT members are skilled in verbal de-escalation techniques, such as using a calm and reassuring tone, validating the patient’s feelings, and offering alternatives to harmful behavior. They may also employ sensory modulation techniques, such as dimming lights, reducing noise levels, or providing weighted blankets or other calming objects to help the patient self-regulate their emotions.
In situations where the patient poses an immediate risk to themselves or others, BERT members are trained in safe physical intervention techniques as a last resort. However, these techniques are always employed with the utmost care and respect for the patient’s dignity and well-being, and only when all other de-escalation strategies have been exhausted.
By having a dedicated team focused on crisis prevention and intervention, mental health units can significantly reduce the need for seclusion and restraint, creating a safer and more therapeutic environment for both patients and staff.
Proactive Crisis Prevention
Pinpoint's De-escalation Technology
Pinpoint aids de-escalation enables immediate intervention, notifying the appropriate team to respond with calming techniques before the situation worsens. By integrating this tool into their response protocols, behavioral health units can prevent crises from escalating, reducing the need for seclusion or restraint and promoting a safer, more therapeutic environment for all involved.
Learn how Pinpoint can transform your mental health unit into a safer, more responsive space. Get a demo to explore how our technology can support your commitment to exceptional patient care and staff well-being.