There is No Such Thing as a “Safe Restraint”

“There is no such thing as a ‘safe restraint,” says Aaryce Hayes, senior vice president of operations for The Mandt System®, which trains organizations in humane techniques for intervening in emergency situations. In this podcast interview with the Hogg Foundation, Hayes explores the need, misconceptions, and keys in reducing seclusion and restraint.

When people think of “restraints,” particularly in psychiatric settings, the image that comes to mind is the straight jacket. But in fact, a more precise definition of restraints point to any immobilization of a body or a portion of a body. That could include physical, mechanical, and medicinal or chemical restraints, among others. These methods are used much too frequently to control people in psychiatric settings.

The harm these interventions cause includes physical injuries to the person being restrained, as well as the staff member administering the restraint. But the physical injuries are only a part of the picture. Having to be restrained is traumatizing or re-traumatizing to the patient.

“We need to realize that when individuals come into this setting, they have been abused, neglected, traumatized. They are often very fearful,” adds Hayes.

In many cases, the person in care resorts to aggressive behavior as a way to indicate fear and the need for space. And often the staff response, unfortunately, is to further encroach on the individual. Instead, the issue should focus on leading with trauma-informed, methods of intervening with individuals in distress.

Obstacles and Alternatives

While limited resources are often cited as a reason for seclusion and restraint tactics, Hayes suggests that re-training must begin with a culture change. One resource that has provided concrete strategies is a report by the National Association of State Mental Health Program Directors titled 6 Core Strategies to Reduce the Use of Seclusion and Restraints. While this work originated through work of state hospitals, it is applicable beyond that population.

Hayes discusses the Mandt System’s integrated approach of building trust and relationships as a key component. The method is a trauma-informed approach to prevent, de-escalate, and if necessary, intervene when the behavior of an individual poses a threat of harm to themselves or others.

In addition, she credits the Hogg Foundation for being helpful in bringing educational resources to Texas.

The Hogg Foundation is deeply committed to humane, evidence-based approaches to working with persons experiencing mental health crises.

In 2007, the Hogg Foundation launched the Seclusion and Restraint Reduction Leadership Group, a working group of mental health experts and stakeholders who are committed to reducing the use of seclusion and restraints in a wide range of settings. The leadership group promotes alternatives through research, policy analysis, technical assistance and more.

In 2014, Hogg awarded a grant to Texas Network of Youth Services to assume coordination of this group, TNOYS continues to uphold this valuable resource.

Seclusion and restraint interventions represent a failure in treatment that can cause trauma and injury to clients and staff. Read more about our work in this area in Seclusion and Restraint Reduction Initiative.

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