Restraint and seclusion are emergency interventions used in clinical, educational, and residential settings to manage behavioral crises when an individual presents an immediate danger to themselves or others. Physical restraint involves manual holds or mechanical devices to restrict a person’s movement. Seclusion is the involuntary confinement of a person alone in an area from which they are physically prevented from leaving. These practices are considered measures of last resort, used only after less restrictive interventions have failed to de-escalate the situation.
Immediate Physical Dangers
The most fatal risk of physical restraint is positional asphyxia, which occurs when a person’s body position interferes with their ability to breathe. This is often associated with prone (face-down) restraints or any position that compresses the chest or abdomen, preventing the full expansion of the lungs. The risk is heightened in individuals who are struggling, have pre-existing respiratory or cardiac conditions, or are experiencing agitated delirium.
A restrained individual’s increased physical exertion elevates their need for oxygen, but the restrictive position prevents them from inhaling deeply enough. This oxygen deprivation can rapidly lead to cardiac rhythm disturbances and death, sometimes in minutes. Other direct physical injuries include musculoskeletal damage, such as fractures and dislocations, resulting from improper application or struggling against a mechanical device.
Prolonged restraint carries additional dangers, including circulation problems and the formation of deep vein thrombosis (DVT). DVT is a blood clot that can become life-threatening if it travels to the lungs. Dehydration, exhaustion, and pressure injuries can also develop when a person is immobilized for an extended period.
Psychological and Emotional Trauma
Being physically overpowered and confined can immediately trigger a stress response in the brain, often described as a “fight-flight-freeze” reaction. Individuals commonly report feelings of terror, panic, and helplessness while being restrained or secluded. This sense of powerlessness and loss of control can be destabilizing, especially for those with a history of prior trauma.
These interventions cause emotional distress, humiliation, and a loss of personal dignity. For many, the experience mirrors past traumatic events, which can re-traumatize them and exacerbate existing mental health symptoms. Research indicates that a substantial percentage of individuals subjected to restraint or seclusion may develop symptoms resembling Acute Stress Disorder or Post-Traumatic Stress Disorder (PTSD).
Seclusion, in particular, can induce feelings of loneliness, abandonment, and isolation, intensifying symptoms of anxiety and depression. This psychological harm is a primary concern because it directly undermines the goal of therapeutic care. The emotional damage creates a lasting psychological burden that impairs a person’s mental well-being long after the intervention has ended.
Long-Term Behavioral Consequences
The application of restraint or seclusion rarely teaches effective coping or communication skills, often proving counterproductive for long-term behavioral change. Instead of learning to manage emotions, individuals may learn superficial compliance, followed by an escalation of challenging behaviors, creating a negative feedback loop. This process can lead to learned helplessness, where the person stops attempting to communicate needs because they believe their actions will not prevent the restrictive intervention.
A consequence is the erosion of trust between the individual and the caregivers, staff, or educators involved. The use of force or isolation can damage the therapeutic alliance, making future psychological treatment more difficult. This damage can lead to increased resistance and non-compliance, contributing to a higher likelihood of future restraint incidents and worsening problematic behavior.
Systemic and Legal Ramifications
The improper or excessive use of restraint and seclusion exposes institutions to systemic and legal risks. Facilities, including hospitals, residential centers, and schools, may face regulatory penalties, fines, and the loss of accreditation for non-compliance with safety standards. Civil litigation is a common outcome, with individuals and families pursuing lawsuits based on claims of negligence, abuse, or violation of civil rights.
Federal and state laws strictly mandate that these interventions be used only in genuine emergencies and as the last resort. Any use for staff convenience, punishment, or coercion is prohibited by law and professional standards. Staff members who perform the restraint also face a risk of physical injury, which can lead to increased workers’ compensation costs and higher rates of staff turnover.