Seclusion and Restraint Reduction

Destroying Sanctuary New Book by Sandra Bloom and Brian Farragher

 In their new book, Destroying Sanctuary, (Oxford University Press, USA; 2010) Sandra Bloom and Brian Farragher present an insightful and sobering exploration of the current state of service delivery in human services agencies.

They postulate that organizations are living organisms, and are subject to the same trauma symptoms that people exhibit. Destroying SanctuaryThey examine the stressors on the modern social service organization and demonstrate how trauma symptoms, parallel to those seen in people, manifest in organizations.  These include such things as loss of emotional management, ethical dilemmas, authoritarian hierarchies, a workforce crisis, conflict, overuse of punishment, poor decision making, inability to learn, lack of safety, problems in communication, learned helplessness, and unresolved grief. These  contribute to an unhealthy work environment where little attention is paid to the physical and mental health of the people actually delivering the services. 

Bloom and Farragher give many examples of their thesis. Here is one. 

In the human response to stress, fear often becomes a way of life resulting in a person being in a chronic state of hyperarousal with serious negative consequences for the body and mind.  Similarly, human service systems in chronic crises also function in a hyperaroused state where there is little safety and stress is cumulative.  Employees display impairment in emotion management and cannot learn well when is this state.  Communication, the life blood of every organization, is besieged resulting in miscommunication, one-way communication, conflict, secrecy, narrowing of focus, and control measures which eliminate complex team discussions.

Sandra Bloom, MDBrian FarragherThe authors suggest that, for indiviudals and organizations, attachment is the human operating system, the basic underlying process which makes it possible for all the other functions to work (like Windows on a computer). Trauma is a virus, like a computer virus, that attacks the human operating system resulting in impaired individual and group attachment.

The book identifies many processes that are familiar to those working in social services settings. Readers will find themselves thinking, “Aha, so now I understand what is going on! Now I can identify the problem I am experiencing!” While the problems are often daunting, understanding the dynamics of trauma organized systems can help organizations to deal with the pressures more effectively, adapt without becoming cruel, and promote love and care in the system even in the face of great difficulties.  Like individuals, organization can understand that much of the problem is not their fault, but they still must take responsibility for making different choices to create a compassionate setting for staff and clients.

Through the Sanctuary Foundation Bloom and Farragher aim to create a new operating system to restore a sense of sanctuary in human service organizations. They promise to offer more detail about this process in their next book.

For a more complete summary of Bloom and Farragher’s theories, click here. Destroying Sanctuary TSI

Helping Traumatized Children Learn

Helping Traumatized Children Learn

supportive school environments for children traumatized by family violence

Massachusetts Advocates for Children: Trauma and Learning Policy Initiative

In collaboration with Harvard Law School and The Task Force on Children Affected by Domestic Violence

A Report and Policy Agenda

Highlights Seclusions and Restraints in Schools


Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers

Highlights of GAO-09-719T, a testimony before the Committee on Education and Labor, House of Representatives

Seclusions and Restraints in Schools


United States Government Accountability Office

Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers

Statement of Gregory D. Kutz, Managing Director, Forensic Audits and Special Investigations

 GAO (1) provides an overview of seclusions and restraint laws applicable to children in public and private schools, (2) verifies whether allegations of student death and abuse from the use of these methods are widespread, and (3) examines the facts and circumstances surrounding cases where a student died or suffered abuse as a result of being secluded or restrained.

Restraint and Seclusion- A Risk Management Guide

 Restraint and Seclusion- A Risk Management Guide

Stephan Haimowitz, J.D. Jenifer Urff, J.D. Kevin Ann Huckshorn, R.N., M.S.N, CAP, ICADC

To minimize these risks, all mental health facilities should develop a risk management strategy that includes  the necessary components described here.

The Economic Cost of Using Restraint

The Economic Cost of Using Restraint and the Value Added by Restraint Reduction or Elimination

Janice LeBel, Ed.D.

Robert Goldstein, Ph.D.


Implementation of a restraint reduction initiative was associated with a reduction in the use of restraint, staff time devoted to restraint, and staff-related costs. This shift appears to have contributed to better outcomes for adolescents, fewer injuries to adolescents and staff, and lower staff turnover. The initiative may have enhanced adolescent treatment and work conditions for staff.

Creating Violence Free and Coercion Free Mental Health Treatment

Creating Violence Free and Coercion Free Mental Health Treatment Environments for the Reduction of Seclusion and Restraint

National Technical Assistance Center

National Executive Training Institute (NETI). (2003, July). Training curriculum for the reduction of seclusion and restraint. Alexandria, VA: National Technical Assistance Center (NTAC), National Association of State Mental Health Program Directors (NASMHPD)

A Snapshot of Six Core Strategies for the Reduction of Seclusion and Restraints

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