The Urgent Need for Change: Addressing Seclusion and Restraint in Canadian Care Settings

A recent Globe and Mail article (“N.B. Hospital Used Seclusion Rooms and Physical Restraints, Report Shows” The Globe and Mail, Sept 24, 2025) highlights a painful reality: adults with complex needs are still being subjected to seclusion rooms and physical restraints in care settings across Canada. These measures are often explained as “last resorts,” but in truth, they are a direct symptom of inadequate resources, insufficient staff training, and a lack of systemic knowledge in positive, evidence-based approaches.

The tragedy is that these situations are preventable. With the right framework, the use of seclusion and restraints doesn’t just decrease—it becomes unnecessary.

Managing Disruptive Behaviours: Why Seclusion and Restraint Persist

When staff lack the training, tools, or systemic support they need, they default to crisis-driven responses. In the moment, physical restraint or isolation may feel like the only option to ensure immediate safety. However, these practices don’t teach skills, build trust, or address the underlying issues. Instead, they often intensify the very behaviours they aim to suppress.

As the article makes clear, this is not just about disruptive behaviour from “those who suffer from severe mental illness…” – it’s about systems failing to invest in approaches that work. When adults in psychiatric care are placed in mechanical restraints or locked in seclusion rooms, the consequences reach far beyond the moment of containment. These interventions, often defended as necessary to keep people safe during a crisis, create harm—physical, psychological, and systemic—that lingers long after the incident has ended.

The Physical and Psychological Impact of Restraints

On the physical level, restraints can cause bruises, cuts, and even broken bones. For patients with pre-existing medical conditions such as heart disease, obesity, or breathing difficulties, being immobilized poses real danger. Prolonged restraint can interfere with circulation, weaken muscles, and in some cases, has led to life-threatening emergencies, including cardiac arrest and suffocation.

The psychological impact is just as severe. Many individuals in psychiatric care have histories of trauma, and the experience of being forcibly restrained or locked away can feel like reliving past abuse. Rather than fostering safety, these measures often instill fear of staff and deepen mistrust of the very people meant to help. Patients describe feelings of humiliation, helplessness, and anger—emotions that erode their willingness to engage in treatment and undermine recovery.

The Cycle of Harm and Its Broader Implications

Instead of reducing challenging behaviour in the long run, restraint and seclusion often make it worse. They may silence or immobilize someone in the moment, but they do nothing to address the reasons for the distress. Patients may emerge angrier, more oppositional, or convinced that they are powerless to change their situation. For some, repeated use of coercion fosters a sense of hopelessness and learned helplessness that worsens their condition.

These harms ripple outward into the system itself. Staff who are asked to restrain or seclude patients frequently report moral distress and guilt, sometimes even their own trauma responses. This contributes to burnout and high turnover, weakening the stability of care.

Over time, the reliance on coercive practices normalizes a culture where force is seen as a substitute for therapeutic engagement. Institutions risk not only ethical compromise but also legal scrutiny, as human rights concerns around these practices grow.

Alternatives to Restraint: The Positive Systems Approach

What makes this reality more troubling is that safer, more effective alternatives are well-documented. Hospitals and agencies that adopt trauma-informed care, structured de-escalation techniques, and system-wide approaches like the Positive Systems Approach consistently reduce their use of restraint and seclusion. These strategies not only protect patients from harm but also create safer environments for staff, proving that coercion is not inevitable.

The use of mechanical restraints and seclusion rooms should therefore be seen not as neutral safety measures but as indicators of systemic failure. They reflect a lack of investment in training, resources, and models of care that are designed to prevent crises rather than contain them. Every time they are used, they send a message that control is valued over healing. For patients already living with the weight of mental illness and trauma, that message cuts deeply.

What a Positive Systems Approach Offers

The Positive Systems Approach (PSA) is designed to replace crisis management with prevention, skill-building, and trust. It rests on two pillars:

• Individual Factors: Identifying triggers, teaching communication, reinforcing positive behaviour, building coping skills, and fostering rapport.

• System Factors: Adequate staffing, consistency, flexibility, portability across settings, intensity of support, and team health.

  
  

When these factors are in place, seclusion and restraint become obsolete.

Consider the case of John, a young man described in our book (“Managing Disruptive Behaviours with a Positive Systems Approach”) who had a history of extreme aggression and property destruction. In institutional care, he was regularly subjected to restraints and secure isolation. Once a Positive Systems Approach was implemented—complete with a trained core team, structured reinforcement, relationship-building, and data-driven planning—his aggression plummeted. Restraints and seclusion disappeared from his life.

The Policy Choice Ahead: A Call to Action

The individuals described in the Globe article were placed in environments without sufficient staff ratios, without consistent caregiver relationships, and without system-level flexibility to adapt supports. These are precisely the conditions PSA is built to correct.

With PSA in place, staff would have been trained to:

• Recognize early warning signs and redirect before escalation.

• Create environments that maximize safety, identify and reduce or change triggers, and create opportunities for success.

• Build rapport so that individuals feel safe, understood, and connected.

• Collect data to continuously refine supports rather than relying on reactive interventions.

  
  

Instead of being isolated in a room or physically overpowered, these individuals could have been taught skills, supported with compassion, and surrounded by an adequate number of trained staff working in a physically appropriate environment. Staff turn to restraints and/or seclusion because they haven’t been given the training, resources, or systemic support to do anything else. This is not about individual negligence—it’s about governments and agencies failing to invest in the necessary resources and environmental modifications.

The use of seclusion and restraint is not inevitable. It is a policy choice. Systems that fail to invest in the right type of training and sufficient staff ratios will keep producing these outcomes. Systems that adopt PSA demonstrate that dignity, safety, and effectiveness can coexist.

Governments, ministries, and agency leaders must move beyond reactive crisis management and resource what we know works. Anything less is an abdication of responsibility to Canadian citizens and frontline staff who deserve better.

In conclusion, addressing the issues surrounding seclusion and restraint requires a commitment to change. By investing in training, resources, and a Positive Systems Approach, we can create a more compassionate and effective care environment for all.