Seclusion & Restraint

Seclusion and restraint raise complex psychiatric legal issues and have become increasingly regulated over the past decade.

Generally, restraints and seclusion are implemented only when a patient creates risk of harm to self or others and no less restrictive alternative is available.

 

Additional restrictions include the following:

  1. Restraints and seclusion can only be implemented by a written order from the physician on duty or physician in charge or the hospital director
  2. Orders are to be confined to specific, time-limited periods
  3. A patient’s condition is regularly reviewed and documented
  4. Any extension of an original order must be reviewed and reauthorized

A. Objectives of Seclusion and Restraint

  1. To prevent clear, imminent harm to the patient or others
  2. To prevent significant disruption to treatment program or physical surroundings
  3. To assist in treatment as part of ongoing behavior therapy
  4. To decrease sensory overstimulation
  5. At patient’s voluntary reasonable request

B. Contraindication for Seclusion and Restraint:

  1. Extremely unstable medical and psychiatric conditions
  2. Delirious or demented patients unable to tolerate decreased stimulation
  3. Overtly suicidal patients
  4. Patients with severe drug reactions, overdoses or requiring close monitoring of drug dosages
  5. For punishment or convenience of staff