What are strategies for reducing restraint and seclusion on inpatient units?

Seclusion and restraint are increasingly regarded only as measures of last resort and are not considered to be treatment interventions. Seclusion and restraint should be used only when there is an imminent risk of danger to the individual or others and there are no other safe and effective alternatives. Successful reduction programs use multiple training and environmental components including:

1. Active participation by leaders in developing and applying seclusion and restraint reduction plans and protocols;
2. Training in the management of aggressive behavior;
3. Post-seclusion and restraint review;
4. Patient involvement in their care plan;
5. Prevention tools including de-escalation and communication techniques; and
6. Modifications of the physical environment to promote constructive patient-patient and patient-provider interactions.
   Trauma-informed approaches, which emphasize how behaviors and responses by patients may be related to past traumatic experiences, are increasingly being used in inpatient and emergency department settings.

REFERENCES

National Association of State Mental Health Program Directors. (1999 July). Position Statement on Seclusion and Restraint. Retrieved from: https://nasmhpd.org/content/position-statement-seclusion-and-restraint

Goulet, M.-H., Larue, C., Dumais, A. (2017). Evaluation of seclusion and restraint reduction programs in mental health: A systematic review. Agression and Violent Behavior, 34, 139-146. doi.org/10.1016/j.avb.2017.01.019. https://www.sciencedirect.com/science/article/pii/S1359178917300320