Achieving restraint-free on an inpatient behavioral health unit.

Restraint use in the treatment of mental illness has long been a controversial practice. Regulatory agencies, licensing organizations, and professional and advocacy groups have called for reduction of restraint use. Responding to this call for action, the leadership team of a behavioral health unit in a private, nonprofit community hospital evaluated reducing restraint use. Following training through the National Executive Training Institute of the National Association of State Mental Health Program Directors, a restraint-reduction project team was formed. Instead of reducing restraint use, it was decided to eliminate restraint use. Vision guided, the team developed an action plan. Culture change focused on the Mental Health Recovery Model and principles of trauma-informed care. Emphasizing person-centered care, this unit has now been restraint free for nearly 2 years. A surprise finding was that restraint elimination accompanied a decrease in use of "as needed" sedative-hypnotic medications. Person-centered care delivered by frontline staff led to culture change, a restraint-free environment, and less medication.