Positive Behavior Supports
Are seclusion and restraint still considered helpful for changing behavior?
Mike Mayer: Seclusion and restraint have been used as excuses for our inability to listen carefully, and to care enough to develop the things that were going to be responsive to the needs of individuals who caused us concerns. Seclusion and restraint are a way, in my opinion, to illegally imprison someone without having to make them leave the building. Illegal imprisonment comes in a lot of different forms. I have yet to see seclusion make anyone more able to interact with other people.
Seclusion is the most severe form of punishment that our penal system has. Isolation. To be kept away from other people. In our penal system, it says that it should be used in the most egregious violations only when the individual cannot be… maintained and not injure someone else, etcetera, etcetera, etcetera, because of the risks associated with isolation. The psychosis, the self-injury, the disassociation where the people literally, their body's in the room but their… their brains have gone somewhere else. The risks associated with isolation have rarely been justified for anything. And they even tried to argue that it was a legitimate torture method, and now they're saying, “Oh, it enhanced interrogations. I mean, I'm sorry, it's not really torture.” And there's debate over whether or not it's legitimate for enhanced interrogations or whether it should be eliminated or not. How can you tell me that taking people away from the world that they're having trouble figuring out and making them spend more time away from other human beings and more time away from people who care about them and more time away from the skills that they need to develop to be able to do those things, is in any way legitimate as a treatment?
Now, I don't know about anybody else, but my experience when I was hospitalized once and, unfortunately, I wasn't responding all that well to the medications that they were giving me, and I was having some behavior problems. Now that meant that I was partially cognizant of what I was doing and my body seemed to be doing things I didn't understand and didn't seem to be able to control at times, and they tied my hands down to the edge of the bed. They were trying to keep me from hurting myself or hurting anybody else, and I understand that. I also understand that in that hospital they came in and they gave me more medications to try and keep me calm and quiet. I understood that. But I also understand that that was because I'd just had a surgery and if I was thrashing around I was going to undo all the good that they'd just tried to do with that surgery. Could I find a way or a time or a reason why somebody might need to be restrained? Yeah, maybe, in an emergency, but not as a planned intervention.
It's not something I do to you because I don't like your behavior. It's not something I do on a routine basis because that's just another form of isolation. I've worked with too many people who have been restrained, as a programmatic treatment, who spend years trying to recover from that. All you have to do is read some… or listen to some of the people who do have language skills who tell us what it feels like to be restrained like that.
And all I can tell you is if my kid is running across the street in front of traffic and he doesn't see the danger, might I grab him and hold him and keep him from doing that? Absolutely. Am I then going to take him into my house and tie him to his bed and tell him he has to stay there for two days because he created an unreasonable risk? What parent would do that? And if we can't legitimize it for anyone else, how can we possibly legitimize it for people who have intellectual disabilities who understand the world even less than everybody else in those kinds of scenarios?
To me, you can't justify behavior that is unethical or immoral because it's convenient, because it's easy, because we've always done it that way, because we don't know what else to do. Figure it out. That's why you're the professional. So do you think I have some strong opinions about it? Pretty strong.