Restraints and seclusion are used on people in institutions, children in schools, nursing home res- idents, general hospital patients, and other loca- tions, but most often with people who have dis- abilities. Questions regarding legality, morality, and efficacy abound. These questions, compounded by the serious possible adverse consequences of re- straints and seclusion, have commanded wide-rang- ing attention from legislatures, government agen- cies, human service professionals, direct care staff, advocates, clients and families, and the public. This article addresses the use of physical restraints and seclusion. It does not address the use of drugs as a behavior restraint, although much of the discussion applies in that context as well.
Is the use of human services restraint therapeu- tic? Can restraint use be reduced or replaced with alternatives? Is it time to relinquish these practices, at least when incorporated in a treatment or habil- itation plan?
In this article I begin with a look at the early institutional use of restraints and seclusion and, as a reminder of what may ultimately be at stake, I note some worst-case results in the United States. I then consider efficacy and risks of ‘‘human services restraint.’’ I review efforts to reform and reduce the use of restraint and address legal liability questions that impact on agency policy and professional be- havior. I conclude with some thoughts on the cur- rent state of knowledge, policies, and practices re- garding human services restraint and on the future of these techniques.
Restraints in the Early Institutions
Dr. John Conolly accepted the judgment of Dr. Robert Hill, who had experimented with nonres- traint at the Lincoln asylum. Dr. Hill had stated, ‘‘In a properly constructed building with [enough attendants], restraint is never necessary, never jus- tifiable, and always injurious’’ (Ozarin, 2001, p. 27). That was 170 years ago.