Being held down, or locked alone in a room, is the part of a psychiatric admission people describe years later. California has a specific statute about it, and it applies to nearly every place a person can be held for psychiatric care.

The short answer: yes, but only in a narrow situation and under rules the facility must follow. A facility "may use seclusion or behavioral restraints for behavioral emergencies only when a person's behavior presents an imminent danger of serious harm to self or others."¹ You have "the right to be free from the use of seclusion and behavioral restraints of any form imposed as a means of coercion, discipline, convenience, or retaliation by staff," including freedom from a drug used to control behaviour "if that drug is not a standard treatment for the person's medical or psychiatric condition."¹ Staff "shall not place a person in a facedown position with the person's hands held or restrained behind the person's back," may not use a technique "that obstructs a person's respiratory airway or impairs the person's breathing or respiratory capacity" or put "a pillow, blanket, or other item covering the person's face" on you, and must give a restrained person "the least restrictive alternative and the maximum freedom of movement" with "the least number of restraint points."¹ A person in seclusion and restraint at the same time must be kept "under constant, face-to-face human observation."¹ And within 24 hours the facility must hold a debriefing with you — and, if you ask, with a family member, partner, significant other or authorised representative who can be there at no cost to the facility — to discuss how to avoid it happening again.² The broader statute says the same thing in fewer words: a right "to be free from harm, including unnecessary or excessive physical restraint, isolation, medication, abuse, or neglect."³

Where these rules apply

The statute reaches "psychiatric units of general acute care hospitals, acute psychiatric hospitals, psychiatric health facilities, psychiatric residential treatment facilities, crisis stabilization units, community treatment facilities, group homes, skilled nursing facilities, intermediate care facilities, community care facilities, and mental health rehabilitation centers," and, separately, state hospitals and facilities run by the Department of Developmental Services.⁴ If you were held on a 5150 anywhere in California, you were almost certainly in one of them.

The words, defined

  • Seclusion is "the involuntary confinement of a person alone in a room or an area from which the person is physically prevented from leaving."⁵ A time-out you can end by walking out is not seclusion.
  • Physical restraint is "the use of a manual hold to restrict freedom of movement of all or part of a person's body, or to restrict normal access to the person's body," used as a behavioural restraint — not gentle comforting or assistance.⁵
  • Mechanical restraint is "the use of a mechanical device, material, or equipment attached or adjacent to the person's body that he or she cannot easily remove and that restricts the freedom of movement of all or part of a person's body or restricts normal access to the person's body, and that is used as a behavioral restraint."⁵
  • Containment is "a brief physical restraint of a person for the purpose of effectively gaining quick control of a person who is aggressive or agitated or who is a danger to self or others."⁵

Before anything happens: the assessment

The statute puts a duty on the facility at the front door. On admission, "or as soon thereafter as possible," it must assess each person, with input from the person and from someone the person wants present, covering:⁶

  • "A person's advance directive regarding de-escalation or the use of seclusion or behavioral restraints";
  • "Identification of early warning signs, triggers, and precipitants that cause a person to escalate…";
  • "Techniques, methods, or tools that would help the person control the person's behavior";
  • "Preexisting medical conditions or any physical disabilities or limitations that would place the person at greater risk during restraint or seclusion"; and
  • "Any trauma history, including any history of sexual or physical abuse that the affected person feels is relevant."

This is the point at which to say, in your own words, what helps and what does not — and to have it written down. A psychiatric advance directive is the statute's own first item.

The limits during a restraint

  • Only for an imminent danger of serious harm to self or others.¹
  • Never as "coercion, discipline, convenience, or retaliation."¹
  • Not on a person whose known medical condition makes it dangerous. A facility "shall not use physical or mechanical restraint or containment on a person who has a known medical or physical condition and there is reason to believe that the use would endanger the person's life or seriously exacerbate the person's medical condition."¹
  • No face-down with hands behind the back; no technique that obstructs the airway, "including techniques in which a staff member places pressure on a person's back or places the staff member's body weight against the person's torso or back"; nothing covering the face.¹ Prone mechanical restraint is barred for people with known risk factors for positional asphyxia — among them obesity, pregnancy, heart disease and respiratory conditions — unless a physician authorises it in writing case by case.¹
  • Least restrictive alternative, maximum freedom of movement, fewest restraint points.¹
  • Not as an extended procedure. Physical restraint or containment "shall not" be used "as an extended procedure."¹
  • Constant face-to-face observation if secluded and restrained at once.¹
  • No chemical control that is not treatment. The right to be free from restraint "includes, but is not limited to, the right to be free from the use of a drug used in order to control behavior or to restrict the person's freedom of movement, if that drug is not a standard treatment for the person's medical or psychiatric condition."¹ The broader statute adds that medication "shall not be used as punishment, for the convenience of staff, as a substitute for program, or in quantities that interfere with the treatment program."³

Afterwards: the review and the debriefing

Every episode gets "a clinical and quality review."² And "as quickly as possible but no later than 24 hours after the use of seclusion or behavioral restraints," the facility must hold a debriefing with you, "and, if the person requests it, the person's family member, domestic partner, significant other, or authorized representative," together with the staff involved, "if reasonably available," and a supervisor, "to discuss how to avoid a similar incident in the future."² Your participation "shall be voluntary."² The debriefing's stated purposes include helping you identify what set the incident off, helping staff develop other ways to help you, revising the treatment plan, and assessing "whether the intervention was necessary and whether it was implemented in a manner consistent with staff training and facility policies."² The facility must document in your record that the debriefing took place and what changed in the plan.²

If no one has offered you a debriefing within a day, ask for it by name. It is the statute's own mechanism for putting your account on the record.

Who to tell

Every psychiatric patient has the right "to see and receive the services of a patient advocate who has no direct or indirect clinical or administrative responsibility for the person receiving mental health services."⁷ Each county's mental health director must appoint or contract for patients' rights advocates, whose first listed duty is "to receive and investigate complaints from or concerning recipients of mental health services residing in licensed health or community care facilities regarding abuse, unreasonable denial or punitive withholding of rights."⁸ The advocate has a statutory right of access to you and to the facility.⁸ Who the patients' rights advocate is, and what they can do →

Worked example

A man on a hold is put in four-point restraints after an argument with staff over a phone call. He was not threatening anyone; he was loud. Under the statute the restraint was permissible only for "an imminent danger of serious harm to self or others," not for the argument.¹ He is entitled to a debriefing within 24 hours, to have his sister present at it if he asks and she can attend at no cost to the facility, and to have the record show whether "the intervention was necessary."² The call to the patients' rights advocate is his to make — the list of rights must be posted, and staff can give him the number — and the advocate can investigate a complaint of "unreasonable denial or punitive withholding of rights."⁸

Q&A

Q: They restrained me because I refused medication. Is that allowed? A: Refusing medication is not, by itself, "an imminent danger of serious harm"; only your behaviour at the time can justify restraint, and restraint used as coercion is what the statute forbids.¹ Can they medicate me against my will? →

Q: I was held face-down. A: A face-down position with hands held or restrained behind the back is prohibited outright.¹ Tell the patients' rights advocate the date, the time and who was present.

Q: Is a locked unit "seclusion"? A: No. Seclusion is confinement "alone in a room or an area from which the person is physically prevented from leaving."⁵ A locked ward with other patients is a different question, governed by the hold itself. What is a 5150 hold? →

Q: Nobody debriefed me. It has been three days. A: The statute requires it "no later than 24 hours after."² Ask in writing, and tell the advocate.

Our therapist directory: See its current status →

Related: What is a 5150 hold? → · Can they give me ECT without my consent? → · The hospital won't tell me anything. Now what? →

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Sources

  1. Cal. Health & Safety Code §1180.4 — (b) "may use seclusion or behavioral restraints for behavioral emergencies only when a person's behavior presents an imminent danger of serious harm to self or others"; (d) no restraint on a person with a known condition where use "would endanger the person's life or seriously exacerbate the person's medical condition"; (g) "shall not place a person in a facedown position with the person's hands held or restrained behind the person's back"; (c)(1) no "physical restraint or containment technique that obstructs a person's respiratory airway or impairs the person's breathing or respiratory capacity, including techniques in which a staff member places pressure on a person's back or places the staff member's body weight against the person's torso or back," and (c)(2) no "pillow, blanket, or other item covering the person's face"; (e) prone mechanical restraint barred for persons with listed risk factors absent a physician's written, case-by-case authorisation; (h) "shall not use physical restraint or containment as an extended procedure"; (i) "constant, face-to-face human observation" for concurrent seclusion and restraint; (j) "the least restrictive alternative and the maximum freedom of movement… the least number of restraint points"; (k) "the right to be free from the use of seclusion and behavioral restraints of any form imposed as a means of coercion, discipline, convenience, or retaliation by staff," including the drug clause as quoted — california.public.law.
  2. Cal. Health & Safety Code §1180.5 — (a) "a clinical and quality review for each episode"; (b) the debriefing "as quickly as possible but no later than 24 hours after the use of seclusion or behavioral restraints," its participants, "The person's participation in the debriefing shall be voluntary," and its four purposes; (c) the opportunity to discuss the circumstances and prevention strategies; (d) documentation — california.public.law.
  3. Cal. Welfare & Institutions Code §5325.1(c) — "A right to be free from harm, including unnecessary or excessive physical restraint, isolation, medication, abuse, or neglect. Medication shall not be used as punishment, for the convenience of staff, as a substitute for program, or in quantities that interfere with the treatment program" — california.public.law.
  4. Cal. Health & Safety Code §1180.3(a) (the facility list as quoted) and §1180.2(a) (state hospitals and Department of Developmental Services facilities "that utilize seclusion or behavioral restraints") — california.public.law.
  5. Cal. Health & Safety Code §1180.1 — definitions of "behavioral restraint," "containment," "mechanical restraint," "physical restraint" and "seclusion" as quoted — california.public.law.
  6. Cal. Health & Safety Code §1180.4(a) — the initial assessment "prior to a placement decision or upon admission to the facility, or as soon thereafter as possible," with input from the person and a person they designate, covering items (1)–(5) as quoted.
  7. Cal. Welfare & Institutions Code §5325(h) — the right "To see and receive the services of a patient advocate who has no direct or indirect clinical or administrative responsibility for the person receiving mental health services" — california.public.law.
  8. Cal. Welfare & Institutions Code §5520 — "Each local mental health director shall appoint, or contract for the services of, one or more county patients' rights advocates," whose duties include (a) "To receive and investigate complaints from or concerning recipients of mental health services residing in licensed health or community care facilities regarding abuse, unreasonable denial or punitive withholding of rights guaranteed under the provisions of Division 5"; and §5530(a), advocates "shall have access to all clients and other recipients of mental health services in any mental health facility, program, or service at all times as are necessary to investigate or resolve specific complaints" — california.public.law.

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