A restraint is formally defined as any method, device, or action that limits a person’s freedom of movement, normal physical activity, or access to their own body. The purpose is typically to prevent harm to the individual or others, though the practice is highly regulated and generally considered a last resort intervention. Understanding the different categories of restraint is important because each type carries a distinct set of risks and requires specific protocols for application and monitoring. These methods are broadly categorized into four distinct types based on the means used to achieve the restriction.
Manual and Physical Restraints
Manual and physical restraints involve the application of direct human force to restrict a person’s ability to move. This category focuses on hands-on intervention where staff members use their own body to control or immobilize an individual. Manual restraint is often employed in immediate crisis situations when a person’s behavior presents an imminent danger.
Techniques range from a simple hold to more complex, specialized maneuvers intended to subdue or guide a person. For instance, a trained staff member may use a basket-hold or an arm-lock to prevent an aggressive individual from striking another person. Physical escorts, used to move a resisting person to a designated safe area, also fall under this classification.
Mechanical Restraints
Mechanical restraints involve the use of specialized equipment or devices to limit a person’s mobility. These devices are applied to or placed adjacent to the body and cannot be easily removed by the individual. The defining characteristic is the reliance on a physical object rather than human contact or medication to maintain the restriction.
Examples include specialized belts, soft cuffs, mitts, or vests secured to a bed or chair to restrict the movement of limbs or the torso. Bed rails are also classified as a mechanical restraint if their intent is to prevent the patient from getting out of bed. Application requires continuous monitoring to ensure proper circulation and patient comfort.
Chemical Restraints
Chemical restraints involve the administration of psychopharmacological medication solely to control a person’s behavior or restrict movement. For a drug to be considered a chemical restraint, the intent must be behavioral control, not the treatment of a diagnosed medical or psychiatric condition.
Common agents used include fast-acting sedatives, anti-anxiety medications, or certain antipsychotic drugs. The medication works by inducing a state of calm or sedation that reduces agitation and physical activity. Using a drug to manage an immediate behavioral crisis is an example of chemical restraint when other de-escalation methods have been unsuccessful.
Environmental Restraints and Seclusion
Environmental restraints utilize the physical setting to limit a person’s ability to move freely or access certain items. This restriction is achieved by modifying the immediate surroundings or placing barriers to prevent exit or movement.
Environmental methods include barrier devices, such as a locked door on a unit to prevent a person from wandering outside the facility. Seclusion represents a specific form of environmental restraint, defined as the involuntary confinement of a person alone in a room or area from which they are physically prevented from leaving. Seclusion is exclusively used for the management of violent or self-destructive behavior.