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Ms. Riahi is Senior Director, Professional Practice and Clinical Informatics, Dr. Dawe was Physician-in-Chief, Dr. Stuckey is Scientific Writer, Research and Academics, and Dr. Klassen is Vice President Medical Services, Ontario Shores Centre for Mental Health Services, Whitby, Ontario; Ms. Riahi is also Lecturer, Dr. Dawe is also Associate Professor, and Dr. Klassen is also Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
The authors have disclosed no potential conflicts of interest, financial or otherwise.
Restraint , defined as a procedure that limits movement, is commonly used in mental health care to respond to and manage behavioral emergencies ( Foster, Bowers, Nijman, 2007 ; Kynoch, Wu, & Chang, 2011 ; Sailas & Fenton, 2000 ). There are many types of restraint, including mechanical, physical, and chemical restraint as well as placement in seclusion. Emerging evidence has shown that these methods have significant adverse effects on service users, staff, and organizations, including exacerbation of aggression, injury to staff and clients, increased costs, retraumatization, and impairment of service user-staff relationships ( Ashcraft & Anthony, 2008 ; Bonner, Lowe, Rawcliffe, & Wellman, 2002 ; Fisher, 2003 ; Foster et al., 2007 ; Lebel & Goldstein, 2005 ; Moran et al., 2009 ; Sequeira & Halstead, 2004 ). In response to these negative outcomes, legislations and guidelines have been introduced with the aim of minimizing restraint practices ( American Psychiatric Nurses Association, 2014 ; College of Nurses of Ontario, 2009 ; MIND for Better Mental Health, 2013 ; National Institute for Health and Clinical Excellence, 2005 ; National Offender Management Service, 2015 ; Registered Nurses' Association of Ontario, 2012 ; Royal College of Nursing, 2008 ). The current article reviews restraint minimization strategies and describes implementation of the strategies in a tertiary level mental health care facility.
Literature Review
The Six Core Strategies to Reduce the Use of Seclusion and Restraint (Six Core Strategies) is an evidence-based framework for organizational planning to reduce the use of restraint in health care settings ( Huckshorn, 2004 ). This framework was developed as a guideline to improve recovery-based practices by minimizing aggression and, therefore, restraint. To be applicable in a variety of settings, the framework includes six general strategies and suggestions of how organizations may implement them, with customization...