human rights and legislation who resource book on mental health

MI Principles: Seclusion <strong>and</strong> restraint
Physical restraint or involuntary seclusion of a patient shall not be employed except in
accordance with the officially approved procedures of the mental health facility <strong>and</strong> only when
it is the only means available to prevent immediate or imminent harm to the patient or others.
It shall not be prolonged beyond the period which is strictly necessary for this purpose. All
instances of physical restraint or involuntary seclusion, the reasons for them <strong>and</strong> their nature
<strong>and</strong> extent shall be recorded in the patient's medical record. A patient <strong>who</strong> is restrained or
secluded shall be kept under <strong>human</strong>e conditions <strong>and</strong> be under the care <strong>and</strong> close <strong>and</strong> regular
supervision of qualified members of the staff. A personal representative, if any <strong>and</strong> if relevant,
shall be given prompt notice of any physical restraint or involuntary seclusion of the patient.
(Principle 11(11), MI Principles)
All episodes of physical restraint <strong>and</strong> seclusion should be recorded in a register that is made
available to the review body for its perusal <strong>and</strong> for identification of facilities that may be abusing
these interventions. Information should include details of the circumstances leading to restraint
<strong>and</strong> seclusion, the duration, <strong>and</strong> the treatment given to bring about a speedy termination of the
restraint or seclusion.
Where possible, there should be a legislative requirement to immediately inform patients’ families
<strong>and</strong>/or personal representatives when patients are subjected to seclusion or restraint
procedures.
Seclusion <strong>and</strong> restraint: Key issues
• Seclusion <strong>and</strong> restraint may be permitted by <strong>legislation</strong> when they are the only means
available to prevent immediate or imminent harm <strong>and</strong> danger to self <strong>and</strong> others.
• Seclusion <strong>and</strong> restraints must be used for the shortest period of time (lasting minutes or a
few hours).
• One period of seclusion <strong>and</strong> restraint should not be followed immediately by another.
• There needs to be ongoing active <strong>and</strong> personal contact with the person subject to seclusion
<strong>and</strong> restraint, which goes beyond passive monitoring.
• Legislation should ban the use of seclusion <strong>and</strong> restraints as punishment or for the
convenience of staff.
• Legislation should also promote infrastructure <strong>and</strong> <strong>resource</strong> development so that seclusion
<strong>and</strong> restraints are not used due to such deficiencies.
• Procedure for exceptional use of seclusion <strong>and</strong> restraints:
a) They should be authorized by an accredited mental health practitioner;
b) The mental health facility should be accredited as having adequate facilities for
undertaking such procedures safely;
c) The reasons <strong>and</strong> duration of seclusion <strong>and</strong> restraint <strong>and</strong> the treatment given to
ensure speedy termination of these procedures, should be entered in the patients’
clinical records by the mental health professional authorizing these procedures.
• Records of all seclusion <strong>and</strong> restraint should be recorded in a register, which is
accessible to a review body.
• Patients’ family members <strong>and</strong>/or their personal representatives may need to be
immediately informed when patients are subjected to seclusion or restraint.
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