Restraints and Self-Injury

A few weeks ago, I received a request from a psychiatry resident working at a state prison about the use of restraints with patients who engage in severe self-injury.  He was looking for guidance on the use of physical restraints with this population in prison.  He noted that his role of ordering and monitoring patients in restraints caused him to feel more like a provider for the facility, rather than for the patient.  I shared with him with the best resources I know – Resource Document on the Use of Restraint and Seclusion in Correctional Mental Health Care (http://jaapl.org/content/35/4/417) as well as Dr. Applebaum’s commentary on the same (http://jaapl.org/content/jaapl/35/4/431.full.pdf). As I sat down to write this, I intended to discuss the rules and regulations surrounding restraint (e.g., Center for Medicare and Medicaid Services (CMS) 42 CFR § 482.13) but I stopped myself.

The inquiry was not about regulations and requirements for the use of restraints.  The question was about patient care. 

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