Seclusion & Restraints: NAMI’s Advocacy Goals and Strategies
What federal protections exist regarding restraints and seclusions?
In October 2000, President Clinton signed the Children’s Health Act of 2000, P.L. 106-310. This significant new law established national standards that restrict the use of restraint and seclusion in all psychiatric facilities that receive federal funds and in "non-medical community-based facilities for children and youth."
What are NAMI’s advocacy efforts regarding restraints and seclusions?
- NAMI strongly supports full implementation of the restraint and seclusion provisions included in P.L 310-106;
- NAMI will monitor the progress of the Department of Health and Human Services in issuing national guidelines and regulations specifying adequate number of staff in facilities and appropriate training in the use of R/S and their alternatives;
- NAMI will also advocate for a national standard in schools, wilderness camps, jails, and prisons.
In addition, NAMI will be following the implementation of key provisions under the general requirements, which include:
For children's non-medical community programs:
- R/S may be used with children in community programs only in emergencies and to ensure immediate physical safety for the child or others. Mechanical restraints are prohibited. Seclusion is allowed only when a staff member continuously monitors a child face-to-face. Time-outs, however, are not considered seclusion, and physical escorts are not considered physical restraints.
- Only individuals trained and certified by a state-recognized body may impose R/S. Until a state certification process is in place, R/S can be used only when a supervisory or senior staff person with skills and competencies specifically listed in the legislation conducts a face-to-face assessment of the child within an hour after R/S is imposed. The use of R/S must then be monitored by the supervisory or senior staff person.
- Required skills and competencies include an understanding of the needs and behaviors of the populations served, relationship-building, avoiding power struggles, de-escalation methods, alternatives to R/S, time limits, monitoring signs of physical distress, position asphyxia, obtaining medical assistance, and familiarity with relevant legal issues.
- Within six months, states (which license such facilities) must develop licensing and monitoring rules and HHS will begin to develop national staffing standards and guidelines.
NOTE: These R/S standards apply only to psychiatric treatment facilities that receive federal funding. They do not affect use of restraint and seclusion in schools, wilderness camps, jails, or prisons. P.L. 106-310 also does not impede any federal or state laws or regulations that provide greater protections than written in the Children’s Health Act of 2000. Thus, rules issued by the Health Care Financing Administration in 1999 that included a requirement for face-to-face evaluations by mental health professionals within one hour of initiating restraint are affirmed.
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