Full access

Letter

Published Online: 1 October 2000

Seclusion and Restraints

Aidan Altenor, Ph.D.Authors Info & Affiliations

Publication: Psychiatric Services

https://doi.org/10.1176/appi.ps.51.10.1318

To the Editor: Several psychiatric hospitals are making significant strides in reducing the use of seclusion and restraints. Pennsylvania's state psychiatric hospitals have set a goal of eliminating seclusion and restraints as treatment interventions. The result has been a marked reduction in their use.

In 1998 the Hartford (Conn.) Courant published a series of articles revealing that 142 deaths occurred during the use of restraints over the previous decade. Close to 30 percent of the deaths were of children under the age of 17. "Treatment" interventions with these outcomes are alarming. They compel us to reexamine our approaches in support of recovery and psychiatric rehabilitation.

It is widely recognized that some conditions may warrant the use of interventions to reduce the likelihood of harm to an individual or others within a care environment. Patients- consumers-psychiatric survivors have emphasized that the use of seclusion and restraints produces more harm than benefit. We have been asked to limit their use to circumstances in which there is an unequivocal likelihood of harm and other, less invasive methods have not been effective.

A cornerstone of the approach in Pennsylvania is that use of seclusion or restraints represents a failure of ongoing psychiatric treatment. Stringent guidelines have been developed for their use that include the following:

• Each use of seclusion or restraints must be ordered by a physician.

• In an emergency, a nurse may order the use of seclusion or restraints; however, the patient must be examined by a physician within 30 minutes of the initial order.

• The length of time per order is limited to one hour.

• An assessment by a physician is required to extend an order beyond the hourly limit.

• The patient and other members of the treatment team participate in a debriefing to review the circumstances that precipitated the incident and discuss ways to avoid similar circumstances.

The National Alliance for the Mentally Ill and the National Mental Health Association have advocated the use of treatment approaches that support recovery and enhance the quality of the lives of persons with mental illness. The increasing availability of state-of-the-art medications and the principles and technology associated with psychiatric rehabilitation make the goal of eliminating seclusion and restraints a reality for the new millennium.

Footnote

Dr. Altenor is superintendent of Norristown (Penn.) State Hospital.

Information & Authors

Information

Published In

Psychiatric Services

Volume 51 • Number 10 • October 2000

Pages: 1318

PubMed: 11013340

History

Published online: 1 October 2000

Published in print: October 2000

Authors

Affiliations

Aidan Altenor, Ph.D.

View all articles by this author

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format	RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks
Direct importt
Citation style
Style

Copy to clipboard
Tips for downloading citations

There are no citations for this item

View Options

View options

PDF/ePub

View PDF/ePub

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login

Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR^® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Seclusion and Restraints

Footnote