The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including “chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. (Endorsed by the State Mental Health Directors, July 13, 1999). (NASMHPD 1999, NASMHPD Position Statement on Seclusion and Restraint. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.)
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References
Binder R., McCoy S. (1983). A study of patients’ attitudes toward placement in seclusion. Hospital and Community Psychiatry 34, 1052–1054
Bullard, L., Fulmore, D., & Johnson K. (2003). Reducing the use of seclusion and restraint: Promising practices and successful strategies. Children’s Welfare League of America. Washington, DC: CWLA Press
Center for Medicaid and Medicare Services (CMS). (2002, October) Testimony from the public hearing on the one hour rule. U.S. Department of Health and Human Services, Baltimore, MD
Children’s Welfare League of America (CWLA). (2002, December) Unpublished meeting proceeding from the CWLA task force on changing the behavioral management of children and adolescents in residential treatment facilities. CWLA, Washington DC
Colton D. (2004). Checklist for assessing your organization’s readiness for reducing seclusion and restraint. Draft. Unpublished Paper. Commonwealth Center for Children and Adolescents, Stanton VA
Conley J. (2004, May). The NTAC training curriculum for the reduction of seclusion and restraint. Evaluation Fast Facts from the Evaluation Center at HSRI 3(1): 1–4
Cusack K. J., Frueh B. C., Brady K. T. (2004). Trauma history screening in a community mental health center. Psychiatric Services 55(2):157–163
Fallot R., Harris M. (2002). Trauma informed services: A self-assessment and planning protocol. Unpublished papers. Community Connections, Washington DC
Felliti V. J., Anda R. F., Nordenberg D. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Prevention Medicine 14(4), 245–258
Hardenstine, B. (2001). Leading the way toward a seclusion and restraint-free environment, Pennsylvania’s success story. Office of Mental Health and Substance Abuse Services, Pennsylvania Department of Public Welfare
Hawryluk, M. (2002, December 23/30). CMS reconsidering the one-hour rule for restraint use: Doctors, hospitals seek to overturn the requirement of a face-to-face physician evaluation within this restrictive time frame. Amednews.com. The newspaper for America’s physicians
HCFA Final Rule. (2001). Medicaid Program Use of restraint and seclusion in psychiatric residential treatment facilities providing psychiatric services to individuals under age 21. 42 CFR Parts 441 and 483. U.S. Department of Health and Human Services, Baltimore, MD
HCFA Interim Rules. (1999). Medicare and Medicaid Programs; Hospital conditions of participation: Patient’s Rights. 42 CFR Part 482. U.S. Department of Health and Human Services, Baltimore, MD
Hodas G., Lieberman R. (2004, Winter). Is Seclusion and Restraint a therapeutic intervention or a therapeutic failure?. CWLA Residential Group Care Quarterly 4(3):11–14
Holzworth R., Willis C. (1999). Nurses’ judgments regarding seclusion and restraint of psychiatric patients: A social judgment analysis. Research in Nursing and Health 2:189–201
Huckshorn, K. A. (2002). Unpublished meeting proceedings from the CMS Town Hall Meeting on the One-Hour Rule. Held October 2002 in Baltimore, MD.
Huckshorn, K. A. (2004). Non-abusive psychological and physical intervention for a safer workplace. NAPPI International Training Program. Held on March 8–10, 2004. Augusta, ME: NAPPI, Inc
Institute of Medicine (IOM). (2001). Crossing the quality chasm: A New Health System for the 21st Century. Institute of Medicine of the National Academies, Washington, DC
Joint Commission on Accreditation for Healthcare Organizations (JCAHO). (2004a). Standards for behavioral health care. JACHO, Oakbrook Terrace, IL
Joint Commission on Accreditation for Healthcare Organizations (JCAHO). (2004b). Accreditation manual for hospitals. Standards for accreditation. JACHO, Oakbrook Terrace, IL
Kessler R. C., Sonnega A., Bromet E., Hughes M., Nelson C. B. (1995). Posttraumatic stress disorder in the national comorbidity study. Archives of General Psychiatry 52: 1048–1060
LeBel J., Goldstein R. (2004). Cents and sensibilities. A presentation at the National Association of State Mental Health Program Directors Research Institute Conference in Arlington, VA. Massachusetts Department of Mental Health, Boston MA
Longest B. B. (2002). Health policymaking in the United States. (3rd Ed.) Health Administration Press, Chicago, IL
Mohr W. K., Anderson J. A. (2001). Faulty assumptions associated with the use of restraints with children. Journal of Child and Adolescent Psychiatric Nursing 14(3): 141–151
Mueser K. T., Goodman L. B., Trumbetta S. L., Rosenberg S. D., Osher F. C., Vidaver R., Auciello P., Foy D. W. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology 66: 493–499
National Alliance for the Mentally Ill (NAMI). (2003, January 11). A summary of reports of restraints and seclusion received since the October 1998 investigation by the Hartford Courant. Retrieved from the Internet January 11, 2003 from http://www.nami.org/update/hartford.html
National Association of Consumer/Survivor Mental Health Administrators. (2003, in draft form). Roadmap to a restraint free environment. U.S. Department of Health and Human Services, Rockville, MD
National Association of Protection and Advocacy Systems (NAPAS). (2004). Restraint and seclusion: Overview of federal laws and policies. Prepared by Gary Gross, Senior Public Policy Counsel. Retrieved from the Internet on January 15, 2004 from http://www.napas.org/AbuseNeglect/Restraint
NASMHPD Medical Directors Council. (1999). Reducing the use of Seclusion and Restraint. National Association of State Mental Health Program Directors (NASMHPD), National Technical Assistance Center for State Mental Health Planning (NTAC), Alexandria, VA
National Association of State Mental Health Program Directors (NASMHPD). (1999, July 13). NASMHPD Position Statement on Seclusion and Restraint. National Association of State Mental Health Program Directors (NASMHPD), National Technical Assistance Center for State Mental Health Planning (NTAC), Alexandria, VA
NASMHPD Research Institute, Inc. (NRI). (2004). Behavioral healthcare performance measurement system. Available online at http://www.rdmc.org/nripms/
NASMHPD. (2002; 2003 revised)). National Executive Training Institute on the reduction of the use of seclusion and restraint Draft training curriculum. National Technical Assistance Center for State Mental Health Planning (NTAC), Alexandria, VA
Office of the Ombudsman for Mental Health and Mental Retardation (OOMHMR). (2002). Current issues in seclusion and restraint State of Minnesota unpublished policy paper. Office of the Ombudsman for Mental Health and Mental Retardation, St. Paul, MN
Onken S., Dumont J., Ridgeway P., Dornan D., Ralph R. (2002). Mental health recovery: What helps and what hinders? A national research project for the development of recovery facilitating system performance indicators. National Association of State Mental Health Program Directors (NASMHPD), National Technical Assistance Center for State Mental Health Planning (NTAC), Alexandria, VA
The President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America Final report. DHHS Pub. No. SMA-03–3832. U.S. Department of Health and Human Services, Rockville MD
Ralph R. (2000). Review of the recovery literature: A synthesis of a sample of the recovery literature, 2000. National Association of State Mental Health Program Directors (NASMHPD), National Technical Assistance Center for State Mental Health Planning (NTAC), Alexandria, VA
Ray N. K., Myers K. J., Rappaport M. E. (1996). Patient perspectives on seclusion and restraint experiences: A survey of former patients of New York State psychiatric facilities. Psychiatric Rehabilitation Journal 20(1):11–18
Sailas, E., & Fenton, M. (2002). Seclusion and restraint for people with serious mental illness (Cochrane Review). In The Cochrane Library, Issue 2, 2002. Oxford, England: Update Software.
Saxe G. (2003, February). The neurobiological and psychological effects of trauma. A taped presentation for the National Executive Training Institute on the reduction of the use of seclusion and restraint, held in Pembroke Pines, FL. National Technical Assistance Center for State Mental Health Planning (NTAC), Alexandria VA
Schacht L. M. (2004). Seclusion and restraint reduction project evaluation. Unpublished report. National Association of State Mental Health Program Directors Research Institute, Inc. (NRI), Alexandria VA
Steele E. (1999). Seclusion and restraint practice standards: A review and analysis. National Mental Health Association Consumer Support Technical Assistance Center. National Mental Health Association (NMHA), Alexandria, VA
Substance Abuse and Mental Health Services Administration (SAMHSA). (2004). SAMHSA priorities: Programs and principles matrix. Retrieved from the Internet on January 5, 2004 at http://www.samhsa.gov/policy/content/matrix
Success stories and ideas for reducing restraint/seclusion. (2003). A compendium of strategies created by the American Psychiatric Association (APA), the American Psychiatric Nurses Association (APNA), the National Association of Psychiatric Health Systems (NAPHS) and the American Hospital Association Section for Psychiatric and Substance Abuse Services (AHA). Retrieved from the Internet on January 10, 2004 at http://www.naphs.
United States General Accounting Office (USGAO). (1999, September) Mental health: Improper restraint or seclusion use places people at risk. GAO/HES-99–176. United States General Accounting Office, Washington DC
Weiss, E. M., Altimari, D., Blint, D. F., & Megan, K. (1998, October). Deadly restraints: A nationwide pattern of death. The Harford Courant
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Huckshorn, K. Re-Designing State Mental Health Policy to Prevent the Use of Seclusion and Restraint. Adm Policy Ment Health 33, 482–491 (2006). https://doi.org/10.1007/s10488-005-0011-5
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DOI: https://doi.org/10.1007/s10488-005-0011-5