Wild Boys in White Attire

Seclusion is the process of placing the patient alone in a lockable room that is equipped with a security window for observation. The principle of seclusion is containment. Physical restraint is a similar approach to aggressive behavior. One staff member becomes the team leader to organize and direct the planned, coordinated "attack," while a different staff member continues talking to the agitated patient. Meanwhile, a third staff member herds the calmer patients into the dayroom. The team then approaches the angry patient, in a show of force. Physical contact is strictly protective and defensive. In the seclusion room, wrist and ankle restraints, often made of leather lined with sheepskin, are applied to all four extremities and buckled to the frame of the bed.

It is no secret that physical restraint and seclusion pose an inherent risk to the general safety and psychological well-being of the patient and staff. The practice of physical restraint and seclusion is refined only, only in an emergency situation, like an assault.

A physician's order is required; this signature can be obtained during the procedure itself. Any verbal order must be countersigned. Staff shall perform a face-to-face physiological and psychological assessment within one hour of implementation of the restraint. Here, the patient shall be informed of the reason for restraint. In no scenario shall the order for restraint/seclusion surpass four hours. The patient may allow staff to notify their family of the procedure. I think my parents would be allowed to know whether or not their son was a well-behaved boy in a mental institution.

Patients in full-bed restraints shall be regularly observed. Injuries must be accounted for, and patients must be offered water and an opportunity to use the bathroom at least every two hours. Sort of like an animal, no? Believe me, it could be worse. Circulation of each restrained limb is to be checked, including range of motion. Vital signs must also be noted.

Patients in seclusion have no access to shoelaces, belts, sharp objects, etc. Pretty much any item capable of inflicting bodily harm is eliminated. The seclusion room itself is plain, and the room may be locked or unlocked. It is considered seclusion if the patient is under the impression he/she cannot leave.

Younger patients, patients with shorter lengths of stay, and patients who were involuntarily committed to treatment are most likely to be secluded or restrained, according to research. As I write this, I am proud to admit the policy of restraint/seclusion is rarely enforced at the LRC. I recall hearing stories. A psychiatric hospital is a treatment center, not a prison. I feel grateful to volunteer at an institution where rehabilitation is the aim, inhumane confinement a distant memory.

Gender must now be evaluated. Men restrain because they can restrain. Power trip, anybody? My opinion is that a petite female tech would be less likely to restrain a man but equally likely to restrain a woman. I shudder to think a man would restrain a female patient for sexual arousal.