An exploration of youth physically restrained in mental health residential treatment centers

Youth are physically restrained in residential treatment centers to prevent them from harming themselves or others, and this practice is common in treatment settings. Consequences from restraint (including clinical, emotional, and physical harm; even death) demonstrate the necessity of reducing restraint use. These consequences may be more severe for youth who have experienced trauma, a population that is disproportionately represented in residential treatment facilities. Using a large dataset (798 youth in residential treatment centers in the Midwest involved in 13,339 restraint incidents over three years), this paper explores the characteristics of the youth who were restrained (including age, race, sex, and primary diagnosis), the reasons why restraints occurred, when restraints occurred during the day, week, and course of the youth's treatment, and the techniques used to restrain youth. African-American youth were more likely to be restrained, as were younger youth. There were no differences between sex or primary diagnosis. Restraints are more likely to occur early in the week and in the evening hours. A majority of youth ever restrained are restrained within their first five weeks of treatment, including a fifth of youth restrained in their first week. Standing holds are the most common restraint technique, and most youth are restrained using only one hold; a disturbing minority of incidents, however, involve the use of multiple holds, including 7% of incidents involving four or more holds. These exploratory results are discussed in terms of how they may be used to reduce restraints and spur future research.