RESTRAINTS

I've been in restraints and seclusion. As a rape survivor, these things retriggered all of the old feelings of helplessness and further traumatized me. The result was probably ten more years of my life lost to the damn system before I was able to recover and take ownership of my own life.

The APA (American Psychiatric Association) put out a position paper on Seclusion and Restraints several years ago. I used it extensively in fighting for changes in Colorado's statutes. As I recall, the APA booklet talks of "bad practices" including using single point restraints or waist/wrist restraints. In Colorado, single point restraints were used in emergency rooms where, in order to prevent a person from leaving, they were shackled to a gurney.

I also used the theory of "least restrictive treatment" to attack indiscriminate use of restraints and seclusion. I successfully had restraint and seclusion seperated as two seperate interventions. The drafts which I wrote for Colorado's statutes (and which were subsequently adopted after battles for over a year) mandated that staff must only use an intervention for good cause and that cause must be logged. Staff must tell the person of the reason for use of the intervention before the intervention is used in order to give the person a chance to change the behavior that staff feel is warranting the intervention. Other less extreme interventions which have been tried and their outcome must also be documented.

After a person is in seclusion or restraints, there must be face-to-face verbal interaction with the staff and the person stating the criteria for release, again stating the reason for the intervention and offering less restrictive alternatives. This face-to-face interaction must happen at least every fifteen minutes and the outcome must be documented in the chart along with the justification for continuing the intervention for another fifteen minutes. It was my hope that by including this, the staff would find the process too labor intensive to use restraints. I figured that for each person in seclusion or restraints, it would take one staff person full time to do all the talking and charting and it would therefore not be worth it to facilities to use this form of intervention any more. Additionally, this was good clinical practice since it was times for staff to check for proper nourishment, fluids and toileting needs as well as checking circulation and other aspects of the person's condition.

That is sort of what happened. But, on follow-up studies, what was stated was that by forcing staff to use face-to-face verbal interaction with clients, they saw people as people and not as "out-of-control" schizophrenics or whatever. The result was a dramatic decrease in use of either seclusion or restraints and in most instances, they were no longer used at all. Lengths of stay in hospitals went down and even though staff hated it at first, they eventually noticed that there were significantly less assaults on staff and they came to like the statutory changes.

All this happened several years ago and I don't know if things are still that way in Colorado because I don't know if anyone has followed-up and performed the necessary watch-dog tasks to assure that good things continue.

The best form of restraint I've ever had used on me was....a loving hug. Mechanical methods of restraint only further traumatized me.

Makes me wonder why so much of so-called "medical-model" psychiatry has such a strong touch taboo when in reality, most of the rest of medicine recognizes the healing power of touch. After all, it is our largest sense organ.