Preventing Restraint and Seclusion: A Multilevel Grounded Theory Analysis

Evidence does not support the use of restraint and seclusion (RS) to contain patients on psychiatric inpatient units, yet these practices continue to be used and defended. Use of RS often results in serious injuries to patients and psychiatric health care workers. Media exposure and legal challenges have led to negative opinions about RS but not their elimination. Substance Abuse and Mental Health Services Administration set a firm goal to permanently eliminate the use of RS, emphasizing that such practices are non-therapeutic. There is agreement that prevention is central to eliminating RS. The aims of this grounded theory study were to understand the contextual processes in preventing RS and the facilitators and barriers to prevention practice. Barriers include lack of resources at the micro-level, mismanaged messages at the institutional level, and, at the policy level, belief that all simply need a change of heart. Participants in this study did not think that they had adequate staffing, facilities, or education to prevent RS. Most were unaware of RS prevention policies.