CLRP

Restraint and Seclusion

Regulation of the use of restraint and seclusion in facilities such as psychiatric hospitals, schools, group home for persons with cognitive disabilities and hospitals which serve children has increased since 1999. In general, the use of restraint and seclusion is not permitted except in emergency situations and its use must be limited to the shortest amount of time necessary to resolve the emergency. There are federal regulations, state laws, agency and hospital policies that govern the use of restraint and seclusion, and vary based upon the setting.

The Connecticut Patients’ Bill of Rights governing mental health services in inpatient and outpatient settings, enacted in 1971, restricts the use of involuntary seclusion and restraint to situations where “there is an imminent physical danger to the patient or others and a physician so orders.” However, the use of restraints as a “therapeutic practice” continued to be widely accepted.

In 1998, a series of restraint-related deaths in psychiatric facilities drew attention to the risks of restraint and seclusion, as did a five part series in the Hartford Courant published in October of 1998 entitled “Deadly Restraints.” This series helped accelerate work on the federal level by the Medicaid and Medicare programs to regulate the use of restraint and seclusion. It also spurred the creation of a State Task Force on Restraint and Seclusion to review state policies.

The DMHAS policies governing the use of restraint and seclusion issued in 2002 (link) establish specific rules for de-escalation to avoid the use of restraint and seclusion, the clinical requirements for ordering the use of restraints or seclusion, ongoing documentation of the continued need for restraint or seclusion, notification of advocates and family members, and de-briefing of both persons who have been restrained and the staff involved in the restraint.

The use of restraints at DMHAS facilities has declined. However, there continue to be situations where the DMHAS policies and procedures regarding restraints or seclusion, including documentation, are not followed.