SAMHSA is committed to eliminating the use of seclusion and restraint in the treatment of people with mental and/or substance use disorders.
Seclusion and restraint were once perceived as therapeutic practices in the treatment of people with mental and/or substance use disorders. Today, these methods are viewed as traumatizing practices and are only to be used as a last resort when less-restrictive measures have failed and safety is at severe risk.
Seclusion is defined as the involuntary, solitary confinement of an individual. Restraint refers to any method, physical or mechanical device, or material or equipment that immobilizes or reduces an individual’s ability to freely move his or her arms, legs, body, or head. A drug or medication also might be used to restrict behavior or freedom of movement.
Studies have shown that the use of seclusion and restraint can result in psychological harm, physical injuries, and death to both the people subjected to and the staff applying these techniques. Injury rates to staff in mental health settings that use seclusion and restraint have been found to be higher than injuries sustained by workers in high-risk industries. Restraints can be harmful and often re-traumatizing for people, especially those who have trauma histories.
Beyond the physical risks of injury and death, it has been found that people who experience seclusion and restraint remain in care longer and are more likely to be readmitted for care.
SAMHSA is committed to reducing and ultimately eliminating the use of seclusion and restraint practices in organizations and systems serving people with mental and/or substance use disorders. SAMHSA’s goal is to create coercion- and violence-free treatment environments governed by a philosophy of recovery, resiliency, and wellness. Successful efforts have eliminated these practices in psychiatric hospitals, forensic psychiatric settings, therapeutic schools, residential treatment centers, and jails and criminal justice settings.
Learn about these safe, effective alternatives to seclusion and restraint in the following resources:
- SAMHSA's Promoting Alternatives to the Use of Seclusion and Restraint Issue Brief #1: A National Strategy to Prevent Seclusion and Restraint in Behavioral Health Services — 2010 (PDF | 498 KB): This issue brief provides information on the history of seclusion and restraint and efforts to reduce and eliminate these practices.
- SAMHSA's Promoting Alternatives to the Use of Seclusion and Restraint Issue Brief #2: Major Findings From SAMHSA’s Alternatives to Restraint and Seclusion State Incentive Grants (SIG) Program — 2010 (PDF | 431 KB): This issue brief summarizes evaluation data from the first cohort of the Alternatives to Restraint and Seclusion SIG program.
- SAMHSA's Promoting Alternatives to the Use of Seclusion and Restraint Issue Brief #4: Making the Business Case — 2010 (PDF | 548 KB): This issue brief summarizes a white paper that describes the systemic, organizational, and personal costs of the continued use of seclusion and restraint practices, as well as cost savings related to reducing the use of these practices.
- SAMHSA's Roadmap to Seclusion and Restraint Free Mental Health Services — 2006: This training manual explores sustainable solutions and strategies for eliminating the use of seclusion and restraint in the treatment of people with mental illnesses and children with serious emotional disturbances.
- SAMHSA's The Business Case for Preventing and Reducing Restraint and Seclusion Use — 2011: This white paper examines the economic impact of restraint and seclusion within organizations. It creates a business case for reducing these practice.
- Restraint and Seclusion: Resource Document from the Department of Education — 2012 (PDF | 1.5 MB): This document describes 15 principles for states, school districts, schools, parents, and other stakeholders to consider when developing or revising policies and procedures on the use of restraint and seclusion with students.
- Six Core Strategies to Reduce Seclusion and Restraint Use from the National Association of State Mental Health Program Directors (NASMHPD) — 2008: This document outlines six core seclusion and restraint reduction strategies. It includes a planning tool to guide the development of a seclusion and restraint reduction plan and an example of debriefing policies and procedures.
- The New York State Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project from Psychiatric Services — 2015: This journal article discusses the implementation and outcomes of the Positive Alternatives to Restraint and Seclusion (PARS) project in three mental health treatment facilities in New York.