Human services restraint: its past and future.

Restraints and seclusion are used on people in institutions, children in schools, nursing home residents, general hospital patients, and other locations, but most often with people who have disabilities. Questions regarding legality, morality, and efficacy abound. These questions, compounded by the serious possible adverse consequences of restraints and seclusion, have commanded wide-ranging attention from legislatures, government agencies, human service professionals, direct care staff, advocates, clients and families, and the public. This article addresses the use of physical restraints and seclusion. It does not address the use of drugs as a behavior restraint, although much of the discussion applies in that context as well. Is the use of human services restraint therapeutic? Can restraint use be reduced or replaced with alternatives? Is it time to relinquish these practices, at least when incorporated in a treatment or habilitation plan? In this article I begin with a look at the early institutional use of restraints and seclusion and, as a reminder of what may ultimately be at stake, I note some worst-case results in the United States. I then consider efficacy and risks of ‘‘human services restraint.’’ I review efforts to reform and reduce the use of restraint and address legal liability questions that impact on agency policy and professional behavior. I conclude with some thoughts on the current state of knowledge, policies, and practices regarding human services restraint and on the future of these techniques.