Organizational Approaches: General Principles

Abstract

This chapter reviews approaches to reduce restraint at the level of organizations. It begins by reviewing the six principles of the National Association of State Mental Health Program Directors approach to restraint reduction which have been used extensively in psychiatric services, but may be useful more generally. These principles include leadership toward organizational change, using data to inform practice, workforce development, specific restraint and seclusion tools, peer roles in patient settings, and rigorous debriefing. The chapter describes examples of such practices. It also identifies counter-habilitative practices, such as denial, word magic, and euphemism for restrictive practices, cheating with data and management practices that implicitly and explicitly undermine restraint reduction. Examples are given from several contexts and populations. The chapter includes data collection and analysis tools and model data sheets that organizations can use to track and evaluate their efforts to reduce restraint and other restrictive behavior management practices.