Lecture – Restraint and Seclusion and Inequalities in Health Care Delivery

Available with English captions.

Janice LeBel, EdD, PhD, Massachusetts Department of Health – Visiting Scholar Series

Restraint and seclusion are not safe procedures. They have a negative impact on psychiatric treatment. They are also used on certain groups—particularly racial groups—far more than others.

These are some of the assertions Janice LeBel, EdD, PhD, ABPP, makes in this lecture. LeBel challenges foundational assumptions of restraint and seclusion use in mental health. She draws on historical records and academic research to demonstrate the dangers of these procedures on individuals with psychiatric conditions.

The use of restraint and seclusion has been proven to result in longer hospital stays, greater rates of readmission, higher medication use, and more. The presentation demonstrates how restraint and seclusion use in hospitals and mental health facilities leads to a rise in workplace injuries, increased staff time, and higher costs. It shows how the practices impact treatment outcomes.

Also, LeBel’s talk addresses disparities and inequalities in these practices. She cites multiple studies proving that Black, male, low-income, and other disadvantaged groups are subjected to these procedures far more than other groups.

Some highlights of this lecture are:

  • A discussion of the fundamental assumptions of restraint and seclusion use
  • Research on the impact of restraint and seclusion on treatment
  • An examination of disparity/inequality of restraint and seclusion use
  • A look at practical strategies and resources to address inequalities in restraint and seclusion use

In addition to showing the negative impacts of these practices, LeBel describes how health care organizations can eliminate these practices and create environments that are safer, more efficient, and more effective for mental health patients. Describing reform efforts implemented by the Pennsylvania Adult State Hospital system and the Massachusetts Department of Mental Health, she presents remedies and resources that address fundamental inequality in how these high-risk, potentially lethal procedures are used.

“The goal is not equity and equality in restraint use,” LeBel says. “The goal is equity and equality in not using these procedures.”