R3 Report Issue 44: New and Revised Restraint and Seclusion Requirements for Behavioral Health Care and Human Services Organizations
New and Revised Restraint and Seclusion Requirements for Behavioral Health Care and Human Services Organizations
Effective January 1, 2025, The Joint Commission has approved new and revised requirements for behavioral health care and human services organizations who use restraint and seclusion. These requirements underwent a full revision and will replace the current restraint and seclusion requirements. The revisions reduce redundancies, streamline processes, and remove the physical holding of a child or youth requirements.
The revised requirements eliminate the separate “physical holding of a child or youth” requirements and incorporate this concept into the requirements for restraint and seclusion, as physical holding that restricts freedom of movement is a type of restraint. Physical holding restraints can be as dangerous as other types of restraint and should be held to the same requirements, as evidenced by a study that examined data collected over a 26-year period regarding restraint fatalities among children and adolescents in the United States. The study confirms that deaths do occur from physical holding restraints (that is, without any devices). In this study, 63 of 79 reported deaths were from physical holding without mechanical devices (Nunno et al., 2021). Because of the risks involved with physical holding, organizations will follow the same requirements as other types of restraint.
The Joint Commission’s definition of restraint has also been revised to clarify what is considered a restraint (which includes physical holding) and what is not. The revised restraint and seclusion requirements only apply to physical interventions that are included in the definitions of restraint or seclusion. The requirements do not apply to the examples provided that do not meet the definition of restraint