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Commentary: The Use of Restraint and Seclusion in Correctional Mental Health

Dr. Appelbaum is Professor of Clinical Psychiatry and Director of Mental Health Policy and Research, Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, MA. Address correspondence to: Kenneth L. Appelbaum, MD, 55 Lake Ave. North, Worcester, MA 01655. E-mail: kenneth.appelbaum{at}umassmed.edu

In contrast to the position taken in the American Psychiatric Association's "Resource Document on The Use of Restraint and Seclusion in Correctional Mental Health Care," this commentary proposes limiting the use of mental health restraints to the stabilization of unsafe situations during the time it takes to transfer an inmate to a psychiatric hospital. Jails and prisons are inherently nontherapeutic environments and are not adequate settings for managing mental health emergencies, such as those that require the use of restraints. Correctional conditions often contribute to the onset, and impede the resolution, of the underlying mental health crisis. Attempts to contain mental health emergencies in a correctional setting with an expanded use of restraints can compromise clinical care, overlook the root cause of many crises, impair the role of mental health professionals by blurring the distinction between mental health and security staff, and can lead to a deterioration in the standards of care.