Restraint in Mental Health Facilities

An adult in a public or privately contracted state mental health facility has a right not to be restrained unless he/she is determined to be an immediate danger to self or others. Restraint means the control of a person’s body in order to restrict movement by physically holding or by the use of mechanical or chemical restraints. This does not include protective medical devices used for the protection from injury. Any form of restraint requires a doctor’s order and specific documentation. Restraint is not to be used as punishment, due to lack of staffing, or for the convenience of staff.

Restraint Process

Initiating Restraint

  • Physical and mechanical restraint can only be implemented in emergency situations and the attending physician must be consulted as soon as possible to execute a physician’s order. 
  • While in restraints, a person must be observed at least every 15 minutes for injury or problems with breathing. 
  • At least once per hour, a nurse must do an observation to check for injuries and to take vital signs. 
  • Persons in restraint must be offered the opportunity to drink and to use the toilet upon request and have range of motion, as needed, to promote comfort. 
  • Persons in restraint must be clothed appropriately.
  • Persons must be informed of the behaviors that caused the restraint and what is necessary for release. 
  • The person must be released from restraints within 15 minutes of meeting release criteria.

Limitations on Restraint

  • People cannot be restrained in a prone (face-down) position nor can anything be draped across a person’s face. 
  • Adults, 18 years of age and older, may be restrained for up to 4 hours but must be released as soon as safely possible. 
  • If a person’s behavior continues to be a threat, the doctor can extend the order every 4 hours for a total of 24 hours. 
  • If the person continues to meet criteria for restraint after 24 hours, the physician must physically observe and evaluate the person to determine if the person remains a danger to himself or others.  If so, a new physician’s order must be written. 

Restraint of Minors

Minors, age 9 to 17 years of age, may be restrained for up to 2 hours.    

Release from Restraint

Upon release from restraint the person’s physical condition and psychological condition must be observed, evaluated, and documented.  A therapeutic debriefing lead by senior management must be conducted to ensure that proper documentation took place and to determine if there were any other interventions that could have been used to keep from restraining the person.  The person will be asked to meet with the Treatment Team on the next business day after the restraint to review the incident, to discuss the incident, identify alternative methods for handling crisis situations, address trauma needs, review and update the Personal Safety Plan and modify the person’s plan of care, treatment and services as needed. 

Personal Safety Form

A Personal Safety Form is a document that persons entering a mental health treatment facility are asked to complete.  It allows the person to provide staff with information on the best methods to:

  • help lessen a stressful situation so that restraint and seclusion can be avoided;
  • recognize signs of distress or triggers that upset the person;
  • document information on medications that have helped the person in the past;
  • understand history of trauma;
  • understand history of restraint and seclusion; and
  • obtain information on medical conditions.

Complaints

Every facility must have a complaint process in place to investigate complaints made by a person in the facility or by a guardian, family member, friend, or other interested individual on the person’s behalf.

If you believe that a person has been unjustly restrained or restrained in a manner that violates the person’s rights, contact can be made with the:

  • Florida Abuse Hotline at 1-800-962-2873, or
  • Disability Rights Florida at 1-800-342-0823