Seclusion and Restraint Alternatives

Promoting Alternatives to Seclusion and Restraint through Trauma-Informed Practices

Seclusion and restraints are violent and largely preventable behavioral health practices that are now widely understood to be treatment failures. They are the direct cause of as many as 150 deaths each year in psychiatric and residential mental health facilities and result in hundreds of patient and client injuries. 1 In addition, they are extremely costly in terms of staff injury, time, turnover, and litigation.

For nearly a decade, SAMHSA has been committed to reducing and ultimately eliminating the use of seclusion and restraint in behavioral health and other systems serving people with mental illness and substance use disorders. Through grants to States, technical assistance, and other activities, SAMHSA has supported hundreds of agencies and organizations to inspire leaders, train staff and consumers, and implement practices to reduce the use of these harmful interventions. The most effective alternatives to seclusion and restraint are those practices that recognize and acknowledge the impact of past trauma and violence in the lives of consumers. 2 To promote their use, SAMHSA provides information, technical assistance, and support that are designed to:

  • Increase awareness about the risks of seclusion and restraint;
  • Provide concrete alternatives that are grounded in an understanding of trauma and trauma-informed practices; and
  • Encourage the use of trauma-informed practices in a broad range of service systems.


What is Trauma? [Click for more information]

Trauma occurs when an external threat overwhelms a person's coping resources. It can result in immediate psychological or emotional distress, or it can affect the person's life over a period of time. Examples of traumatic experiences include any type of physical, emotional, or sexual abuse or neglect; witnessing or experiencing deliberate violence; natural disasters; chronic stressors like racism or poverty; and intergenerational or historical trauma. Trauma is unique to each individual; the most violent events are not necessarily the events that have the deepest impact. Sometimes people aren't even aware that their problems are related to events that occurred earlier in life. Trauma affects the developing brain and body and can alter the person's natural mechanism for responding to stress. This can lead people who have experienced trauma to respond to specific events or "triggers" – for example, an unexpected loud noise or unwelcome touch – in ways that others may perceive as an over-reaction or even as threatening behavior.

1 Harvard Center for Risk Analysis (1998).
2 National Association of State Mental Health Program Directors (2005).

Why is Understanding Trauma Important to Reducing the Use of Seclusion and Restraint? [Click for more information]

As many as 90 percent of people receiving public mental health services have a history of trauma. Most data indicate that the vast majority of people receiving services for homelessness or who are incarcerated also have experienced trauma. However, the service systems designed to help them do not always effectively recognize or address the trauma experiences of the people they serve. In fact, through the use of seclusion, restraint, and other violent interventions, these systems actually re-traumatize people and pose a barrier to recovery. The Six Core Strategies to Reduce the Use of Seclusion and Restraint – an approach that has been promoted by SAMHSA to reduce the use of these interventions – is grounded in the idea that systems and services should acknowledge the impact of trauma in people's lives and avoid re-traumatization.

What are Trauma-Informed Practices? [Click for more information]

Trauma-informed practices are policies, procedures, interventions, and interactions among clients and staff that recognize the likelihood that a person receiving services has experienced trauma or violence. Trauma-informed practices – sometimes called trauma-informed care – create healing environments that emphasize physical and emotional safety and promote the development of trusting, collaborative relationships. In a trauma-informed program, everyone, regardless of job level or specific role, is educated about trauma and its consequences. The role of peers – other people who have experienced trauma or violence – is very important in planning and implementing trauma-informed practices. The goal is to create an environment of respect and safety that prevents the need for seclusion and restraint.

What Services are Available? [Click for more information]

SAMHSA offers the following resources, services, and opportunities for partnership in promoting alternatives to seclusion and restraint through trauma-informed practices:

  • Training and technical assistance for organizations in a range of service settings
  • Presentations at conferences, meetings, and workshops
  • Collaboration and co-sponsorship of webinars and materials development
  • Shared e-mail lists and strategies for dissemination of information and resources
  • Connections to State- and community-based organizations promoting alternatives to seclusion and restraint and trauma-informed care
  • Literature, videos, DVDs, and other resources

To request Technical Assistance/Training or a Speaker at your upcoming conference please complete the appropriate form

Webinars,Meetings Information and Resources [Click for more information]