This document defines seclusion and restraint, their indications and risks. Restraint and seclusion should only be used as a last resort to control behavioral emergencies and address underlying needs. They are not therapeutic and can cause physical and psychological harm. Restraint includes physical force, devices, or chemicals to immobilize, while seclusion involves confining alone in a locked room. Indications are prevention of harm, but not for punishment or convenience. Risks include feelings of humiliation, aggression, pressure ulcers, falls, and death.

1. SECLUSION & RESTRAINT

2. OBJECTIVES
 Introduction
 Definitions
 Indications & Contraindication
 Risk and side effects of restraint use.

3. INTRODUCTION
 Restraint and seclusion are behavioral
management interventions that should be used as
a last resort to control a behavioral emergency.
 Behavioral emergencies are often the result of
unmet health, functional, or psychosocial needs,
and you can often reduce, eliminate, or manage
such emergencies by addressing the conditions
that produced them.

4. CONT.…
 Restraint and seclusion are not therapeutic care
procedures. In fact, restraint and seclusion can
induce further physical or psychosocial trauma.
 In short, these procedures pose a safety risk to
the emotional and physical well-being of the
person and have no known long-term benefit in
reducing behaviors'.

5. DEFINE RESTRAINT
 Restraints include the use of physical force,
mechanical devices, or chemicals to immobilize a
person.
 This is defined more specifically in the UK as
direct contact with an intention to prevent, restrict
or subdue a person's movement in order to
prevent harm or give treatment (Bowers et al,
2012).May 4, 2018.

6. CONT. …
TYPES OF RESTRAINTS
There are three main types of restraints:
 Physical restraints that restrict or control
movement or behavior. They may be attached to a
person’s body or create physical barriers.

7. CONT.…
 Chemical restraints that are medications used to
modify or restrict behaviour. For example,
tranquilizers & sedatives.
 Environmental restraints that change or modify
a person’s surroundings to restrict or control
movement. For example, a locked door.

8. DEFINE SECLUSION
 Seclusion, a type of restraint, involves confining
a person in a room from which the person cannot
exit freely.
 Seclusion is a tool used by psychiatrists primarily
to manage aggressive and disturbed behavior that
is presumed to be due to the patient's mental
disorder.
 Expert opinion recommends a combination of
national policy, ward management and patient
centred interventions to reduce seclusion rates.

9. CONT.…
 Seclusion is defined as the involuntary
confinement of a patient alone in a room, with the
patient physically prevented from leaving for any
period.
There are 4 variants to seclusion:
 Placing a patient in a locked room.
 Placing a patient in a room with the door held shut.
 Placing a patient in a room in which freedom is
restricted.
 Separation of a patient from the group.

10. INDICATIONS & CONTRAINDICATION
 The chief indication for placing a patient in restraint or
seclusion is prevention of harm to himself, other patients,
or staff.
 Patient requests
 Prevention of destruction of property
 Prevention of significant disruption of treatment programs
 Assistance in treatment as part of ongoing behavior
therapy
 Decreasing overstimulation
 Disruption of a treatment program or chaotic behavior.
 The patient's chaotic or disruptive behavior is a prelude to
danger.

11. CONTRAINDICATIONS
Reasons for which restraint and seclusion should not be
used include:
 Punishment
 Convenience
 Preventing a voluntary patient from leaving
 Lack of resources to supervise the patient adequately
 Delirium or dementia
 Severe drug reactions
 History of self-injury or aggression
 Maintaining an orderly treatment environment
 A medically unstable state
 Inability to perform one-to-one observation.

12. RISKS AND SIDE EFFECTS OF RESTRAINT
USE
Psychological/Emotional Effects
 Feelings of humiliation, loss of dignity
 Diminished quality of life; increased stress,
confusion, fear .
 Depression, withdrawal, isolation, desolation;
loss of hope and internal motivation
 Anger, frustration, demoralization
 Increased agitation, hostility, and aggression;
learned dependence .
 Diminished staff opinion of the resident

13. PHYSICAL EFFECTS
 Pressure ulcers and skin irritation
 Bone loss from decreased weight-bearing activity
 Stiffness and muscle atrophy from lack of use
 Increased risk of respiratory infection
 Reduced functional capacity, decreased
ambulation
 Increased risk of contractures
 Decreased mobility
 Deconditioning
 Physical discomfort, increased pain

14. CONT.….
 Serious injuries from falls
 Increased morbidity and mortality
 Increased risk of death from struggling to get free
 Increased stress on the heart
 Increased risk of death due to strangulation or
asphyxiation
 Risk of burns if trying to burn the restraint off.
 Risk of injury from restraint friction on the skin.

15. CONT.…
 Nerve injuries
 Increased constipation, increased risk of fecal
impaction
 Increased incontinence
 Increased risk of urinary tract infection due to
urinary stasis
 Sleep disturbances
 Restricted circulation
 Decreased appetite

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