Case study: when restraints are the least restrictive alternative for managing aggression.

This article discusses the controversial use of restraints with a persistently violent adolescent on a child and adolescent psychiatry unit. The authors present an individualized program that used a series of ambulatory restraints on a long-term basis and prophylactically to contain the aggression of a psychotic girl. Clozapine was used concomitantly to control her psychosis. The prophylactic use of mechanical restraints allowed this teenager to be integrated into the milieu and to receive multiple treatments that the standard protocol precluded. This case underscores the difficulties in managing aggression when youths do not respond to standard protocols and do not conform to our assumptions about the least restrictive alternative. It is concluded that prophylactic mechanical restraint provided the least restrictive alternative to personal freedom for this teenager and had therapeutic benefit.