Non-restraint (Hill, Conolly)

1. Introduction

Version followed: the movement as documented in its two founding public-domain texts, Robert Gardiner Hill's Total abolition of personal restraint in the treatment of the insane (lecture delivered at the Mechanics' Institution, Lincoln, 21 June 1838; published London: Simpkin, Marshall, [1839]) and John Conolly's The treatment of the insane without mechanical restraints (London: Smith, Elder, 1856), read through the historical assessments of Haw (1989), Haw and Yorston (2004) and Topp (2018); the legacy section follows the UK Mental Health Units (Use of Force) Act 2018 with its December 2021 statutory guidance, and US federal hospital rules at 42 CFR 482.13. [source: Wellcome Collection catalogue records; Cambridge University Press; Haw and Yorston 2004; Topp 2018]

Non-restraint was an early-Victorian asylum reform, not a therapy. Its core idea was that the mechanical restraints then routine in British asylums were unnecessary and that patients could be managed, and do better, without them. Edward Charlesworth (physician) and Robert Gardiner Hill (house surgeon) at the Lincoln Lunatic Asylum are generally regarded as its UK pioneers, having ended mechanical restraint there by 1838; John Conolly extended it to Hanwell, the largest county asylum, from summer 1839. [source: Haw and Yorston 2004; Haw 1989] Conolly's 1856 book argues that non-restraint should be the standard in every asylum, with each patient treated as an individual with care and compassion; the publisher's description summarises his Hanwell system as occupation and positive activity, personal freedom and privacy, good food, exercise and, above all, the absence of physical restraint. [source: Cambridge University Press reissue page] The reform's idea of how change happens was environmental and relational: remove the coercion, supply humane surroundings and occupation, and the disturbance that restraint was thought to contain would lessen. [synthesis, from the sources above]

This guide is for the psychotherapist's own work: understanding the movement and its limits, recognising its legacy in today's restraint-reduction law and practice, and working with clients who have experienced restraint or seclusion, whose relatives were in asylums, or who are drawn to asylum history. It does not teach any restraint, seclusion or holding method.

2. Framework

Historical phases (outline)

Before 1838: routine mechanical restraint. Patients in British asylums were commonly restrained by devices that confined the body or limbs, sometimes for long periods; Conolly's book opens with "the last days of the old methods". [source: Cambridge University Press table of contents; plain description of the devices' kind is synthesis] The devices are named here only by kind, never how they were applied.
1837–1838: Lincoln. Charlesworth and Hill ended mechanical restraint at Lincoln by 1838; Hill set out the case publicly in his June 1838 lecture, published in 1839 with statistical tables. [source: Haw and Yorston 2004; Wellcome Collection record of Hill's lecture] Exact year restraint began to be withdrawn at Lincoln [uncertain: not verified].
1838: Northampton. The Northampton Asylum opened on 1 August 1838 under Thomas Octavius Prichard, who presented avoidance of restraint as part of early, gentle, "preventative" treatment; Samuel Tuke praised the absence of restraint on a visit in 1839. Haw and Yorston's case-note study found that Prichard's claim of complete abolition "cannot be substantiated". [source: Haw and Yorston 2004]
1839: Hanwell. Conolly introduced non-restraint at Hanwell in summer 1839, with about 800 pauper patients, most long-term transfers from workhouses. [source: Haw 1989; Haw and Yorston 2004]
1838–1844: the priority and seclusion disputes. Credit for originating the reform was bitterly contested (Hill later argued that Prichard deserved credit for non-restraint in its full extent). Haw and Yorston conclude that abolition was gradual and simultaneous in several asylums, so no single originator can be named. Topp shows that seclusion (locking a patient alone in a room) became a central point of contention, debated in The Lancet, Commissioners in Lunacy reports and pamphlets, with positions ranging from pro-restraint and anti-seclusion to anti-restraint and pro-seclusion; Conolly was seclusion's most committed advocate, and critics linked seclusion to secrecy and to contested solitary confinement in prisons. [source: Haw and Yorston 2004; Topp 2018]
After 1839: spread and codification. Conolly's book traces gradual adoption in large English asylums after 1839 and spread on the Continent, and includes extracts from Hanwell's annual reports for 1839–1849. [source: Cambridge University Press; Wellcome Collection record] Contemporary reviewers engaged with the book (e.g. an 1857 essay review signed "L.A.T."). [source: Wellcome Collection record]
Today: restraint reduction. In England, the Mental Health Units (Use of Force) Act 2018 (Royal Assent November 2018; most provisions in force 31 March 2022) requires each mental health unit to have a responsible person, a published use-of-force policy, patient information, training to Restraint Reduction Network standards, recording of force and independent investigation of deaths and serious injuries. In the US, 42 CFR 482.13(e) bars restraint or seclusion as coercion, discipline, convenience or retaliation. [source: gov.uk consultation response; eCFR] Historians do not draw a straight line from 1838 to these laws; the link is one of ideas and argument. [synthesis]

Phases of the psychotherapist's work

Orientation and historical literacy. Goal: know what non-restraint was, what it did not abolish, and how it is invoked today. Move on when you can explain it accurately and without heroic simplification. [synthesis]
Recognition and assessment. Goal: identify whether the client's concern involves past or current restraint, seclusion or coercive care; family asylum history; or interest in asylum heritage. Move on once the concern, its emotional weight and any current risk are clear. [synthesis]
Safety, rights and safeguarding. Goal: address current risk (suicide, self-harm, ongoing inappropriate restraint, a child or adult at risk) and rights information. Move on when immediate safety and any reporting duty are dealt with. [synthesis]
Processing and repair. Goal: help the client make sense of what happened, reduce trauma symptoms, restore agency, and, for family history, integrate the ancestor's story. Move on when distress is manageable and the client has the meaning they want. [synthesis]
Advocacy and follow-up. Goal: support complaints, advance planning, involvement in co-production, and the therapist's own contribution to less coercive services. [synthesis]

Session number and length follow the client's needs and the setting. Format is ordinary individual or family therapy, with liaison as the client consents. [synthesis]

3. Guiding principles

History in outline, attributed. Practical meaning: describe what Hill, Charlesworth, Conolly and Prichard claimed and what historians found, citing who says what. [source: section 2 sources]
No replication. Practical meaning: describe what restraint and seclusion were and what patients experienced in plain observable terms, so they can be recognised; never describe how to apply a device, hold or seclusion method. [synthesis]
Avoid the heroic narrative. Practical meaning: non-restraint was gradual, multi-site and contested; other coercive measures persisted (Haw and Yorston list solitary confinement, low rations and other physical treatments at Northampton). [source: Haw and Yorston 2004]
Reform can relocate coercion. Practical meaning: when one restrictive practice is removed, watch for others taking its place; the seclusion dispute of 1838–1844 is the historical example. [source: Topp 2018; lesson framed as synthesis]
Least restriction is today's standard. Practical meaning: restraint or seclusion only for immediate physical safety, only after less restrictive measures fail, the least restrictive effective form, ended as early as possible. [source: eCFR 42 CFR 482.13(e); gov.uk consultation response]
The client's experience is primary. Practical meaning: a lawful, recorded restraint can still be traumatic; validate the experience without needing to adjudicate legality first. [synthesis]
Trauma-informed, person-centred stance. Practical meaning: offer choice, control and predictability in sessions, because restraint removes all three. The 2018 Act guidance emphasises trauma-informed, person-centred, recovery-oriented care. [source: gov.uk consultation response]
Equality awareness. Practical meaning: ask about discrimination; the Act's guidance aims to reduce disproportionate force on people with protected characteristics, and respondents highlighted autistic people, people with learning disabilities, children and Black and minority ethnic patients. [source: gov.uk consultation response]
Transparency over secrecy. Practical meaning: help clients obtain records and explanations; Victorian critics linked seclusion to lack of transparency, and today the Act requires recording and published policies. [source: Topp 2018; gov.uk consultation response]
Role clarity. Practical meaning: the psychotherapist never performs, supervises, recommends or teaches restraint or seclusion; your role is assessment, therapy, safeguarding, reporting and advocacy. [synthesis]
Consent in touch and space. Practical meaning: no touch without consent before and during, with a right to stop; never sexual; offer seating and door choices to clients who were restrained or secluded. [synthesis]
Lived experience as expertise. Practical meaning: involve the client in decisions about their care and signpost co-produced resources; NHS England resources on reducing restrictive practice were co-produced with people with lived experience. [source: NHS England]
Respect for the dead and for families. Practical meaning: never name asylum patients from records in public work; use role descriptions and follow archive access rules. [synthesis]

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis]. None involves carrying out, supervising or teaching restraint, seclusion or holding.

4.1 Building your own historical literacy

Purpose / when: before working with clients who raise asylum history, restraint or seclusion, so you can speak accurately.
Steps: (1) Read the founding texts in public-domain digitisations (Hill 1839; Conolly 1856) for the reformers' own arguments, in outline. (2) Read historians who qualify them: Haw and Yorston (2004) on multi-site, gradual abolition and the unsubstantiated claim at Northampton; Topp (2018) on seclusion as the contested replacement. (3) Note the gap between the reformers' claims and the record (e.g. Hanwell's low cure rate in Conolly's own 1847 figures, per Haw 1989). (4) Learn the current rules in your jurisdiction (England: 2018 Act; US: 42 CFR 482.13). [source: Wellcome Collection; Haw 1989; Haw and Yorston 2004; Topp 2018; gov.uk; eCFR]
Example language (illustrative): "The reformers ended chains and straps in some asylums, but historians show that other forms of control, like locking people alone in rooms, stayed and were argued over."
Watch for: retelling a heroic story; repeating priority claims as fact; describing devices or methods. It is working when you can give a balanced two-minute account with sources.

4.2 Responding to a client's interest in asylum history

Purpose / when: a client is reading about, visiting or researching asylums, or mentions Hill, Conolly or Hanwell.
Steps: (1) Ask what draws them: personal experience, family, identity, work, curiosity. (2) Explore the emotional charge (fear of "being locked up", identification with patients, anger). (3) Offer accurate context briefly, attributed. (4) Link the interest to present concerns only if the client does. (5) Agree whether history is a topic for therapy or a side interest.
Example language (illustrative): "You've mentioned Hanwell a few times. What is it about that place that stays with you?"
Watch for: over-identification with historical patients feeding hopelessness about current care; intellectualising to avoid present feelings. Working: the client can hold both the history and their own situation with less distress.

4.3 Supporting family-history work on an ancestor in an asylum

Purpose / when: a client has found, or is searching for, a relative admitted to a nineteenth-century asylum.
Steps: (1) Prepare for what records can contain: diagnoses in period language, descriptions of behaviour, possible references to restraint or seclusion, death in the asylum. (2) Help the client decide pace and support (who will be with them when they open records). (3) Point to formal archives (hospital records held in county record offices and specialist archives; for Hanwell, records are catalogued by archive bodies [uncertain: not verified]) and follow their access rules. (4) Process findings in session: grief, shame, inherited stigma, fear of heredity. (5) Help the client place the ancestor's story in the reform context without excusing or exaggerating it.
Example language (illustrative): "Before you open the case book, let's think about what might be in it and what you'd want afterwards."
Watch for: fears that mental illness is "in the blood"; intrusive imagery from records; pressure to publish names. Working: the client can tell the ancestor's story with compassion and context.

4.4 Assessing a history of restraint, seclusion or coercive care

Purpose / when: at intake for clients with inpatient, secure, care-home, school, custody or emergency-department histories, or when a client hints at being "held down" or "locked in".
Steps: (1) Ask open, non-leading questions about past hospital or residential care. (2) If restraint or seclusion is disclosed, ask about frequency, age, setting, whether anyone explained it, and after-effects (nightmares, avoidance of services, startle, shame). (3) Screen for trauma symptoms with your usual validated tools (described, not reproduced). (4) Ask about current contact with services and fear of readmission. (5) Record carefully, distinguishing the client's account from records.
Example language (illustrative): "Some people who've been in hospital were held or kept in a room on their own. Did anything like that happen to you?"
Watch for: dissociation or shutdown when asked; minimisation ("it was my fault"); disclosures involving a child or ongoing practice (go to 4.10). Working: a clear, client-owned account and a shared view of its impact.

4.5 Psychoeducation on rights and standards

Purpose / when: a client is or may be an inpatient, or is confused about whether what happened was allowed.
Steps: (1) Explain, plainly, the least-restriction standard: restraint or seclusion only for immediate physical safety, after less restrictive measures fail, ended as early as possible, never as punishment, coercion, convenience or retaliation (US federal hospital rule; the English Act's guidance says force is a last resort after de-escalation). (2) Explain that in England each unit must publish a use-of-force policy and give patients information about force and their rights, and that uses of force must be recorded. (3) Signpost the client to ask the unit for its policy and information. (4) Avoid giving legal advice; refer to advocates or lawyers. [source: eCFR; gov.uk consultation response]
Example language (illustrative): "The rules say restraint should only be used to keep someone safe in that moment, never to punish. You're entitled to ask the ward for its written policy."
Watch for: the client using rights information to escalate conflict unsafely on a ward; your own overstatement of the law. Working: the client feels less helpless and knows whom to ask.

4.6 Trauma-focused work after restraint or seclusion

Purpose / when: a client has trauma symptoms linked to being restrained or secluded.
Steps: (1) Establish safety and control in the room first (seating, door, breaks, stop signal). (2) Build a shared formulation of how the experience affected trust, body and self-image. (3) Offer evidence-based trauma treatment within your competence, or refer to a trauma specialist; follow your jurisdiction's PTSD guideline [uncertain: guideline not verified]. (4) Use any exposure-based work only with informed consent, a clear right to stop, and attention to contraindications such as current crisis or ongoing coercive care. (5) Never use touch or physical positioning that resembles holding.
Example language (illustrative): "You can stop at any moment, and you choose how close we get to that memory today."
Watch for: re-traumatisation, dissociation, self-harm urges; the therapy itself feeling coercive. Working: reduced intrusions and avoidance, and more willingness to use services when needed.

4.7 Making sense of a specific incident (post-incident support)

Purpose / when: after a recent restraint or seclusion, when the client wants to understand what happened. NHS England signposts Restraint Reduction Network toolkits on post-incident debriefing. [source: NHS England]
Steps: (1) Ask whether the ward offered a debrief and what it covered. (2) Help the client build a timeline in their own words. (3) Separate what they felt, what they were told, and what records say. (4) Identify triggers and early warning signs they would like staff to know. (5) Decide with the client whether to feed this back to the ward (see 4.8 and 4.9).
Example language (illustrative): "Let's piece together what happened in the order it happened for you."
Watch for: self-blame, or a debrief that functioned as a reprimand. Working: a coherent narrative and concrete preferences for the future.

4.8 Advance and crisis planning

Purpose / when: a client with recurrent admissions wants a say in how a future crisis is handled.
Steps: (1) Explore what helps and what makes things worse in a crisis. (2) Help the client write their preferences in their own words (calming approaches, people to contact, triggers, sensory needs, trauma history they want staff to know). (3) Encourage sharing with the care team and inclusion in the care plan; ask about formal advance statements under local law [uncertain: jurisdiction-specific]. (4) Review after any admission.
Example language (illustrative): "If you became very unwell again, what would you want the ward to know about you first?"
Watch for: the client being told the plan is binding when it is not; plans that list only prohibitions. Working: staff use the plan, and the client feels more agency.

4.9 Supporting complaints and advocacy

Purpose / when: a client wants to challenge how force was used on them.
Steps: (1) Clarify what outcome the client wants (explanation, apology, change, record correction). (2) Help them request the unit's use-of-force policy and their records; English units' policies must cover the complaints procedure. (3) Connect them with an independent advocate; the Act's guidance stresses advocates' involvement in patient information. (4) Help draft a factual account. (5) Prepare for the emotional cost and for slow or disappointing responses. [source: gov.uk consultation response]
Example language (illustrative): "What would a good outcome look like for you, an explanation, an apology, or a change on the ward?"
Watch for: the complaint process re-traumatising; the therapist taking over. Working: the client feels heard and keeps ownership of the process.

4.10 Safeguarding when restraint may be abusive

Purpose / when: a client (or a child or vulnerable adult they describe) reports force used as punishment, threat, convenience or retaliation, injury, or force in an unregulated setting.
Steps: (1) Ensure immediate safety. (2) Explain the limits of confidentiality. (3) For children, follow mandatory-reporting and child-protection routes in your jurisdiction; involve the child at a level suited to their age, seeking assent. (4) For adults, follow adult-safeguarding procedures with consent wherever possible. (5) Know the regulators: in England the Care Quality Commission treats restrictive practice as a risk factor for closed cultures [source: NHS England]; reporting routes to it and to the provider's responsible person [uncertain: route details not verified]. In US hospitals, the federal rule bars such uses and requires hospitals to report restraint- or seclusion-related deaths to CMS [source: eCFR]; external complaint routes vary by state [uncertain]. (6) Document what you heard and did.
Example language (illustrative): "What you've described worries me for your safety. I'd like to talk with you about who needs to know and how we do that together."
Watch for: delaying a report to preserve rapport; promising secrecy. Working: the risk is addressed and the client remains engaged.

4.11 Duties when a colleague or institution misuses restraint or seclusion

Purpose / when: you work in or with a service and see restraint, seclusion or another restrictive practice used against standards, or a culture of routine force.
Steps: (1) Record what you observed factually. (2) Raise it through the service's internal route and with the responsible person where one exists (England's 2018 Act requires units' policies to set out staff duties to spot and report abuse). [source: gov.uk consultation response] (3) Escalate to the regulator or your professional body if internal routes fail [synthesis]. (4) Seek consultation from your own supervisor. (5) If you hold a dual role (for example ward staff member and the client's therapist), consider whether the multiple relationship impairs objectivity or risks harm (APA Ethics Code Standard 3.05). (6) Never take part in or endorse a practice you believe is abusive. [synthesis]
Example language (illustrative, to a manager): "I observed seclusion used after the patient refused medication, which looked like a consequence rather than a safety measure. I'd like it reviewed."
Watch for: retaliation against you; normalisation ("that's how it's done here"). Working: concerns are logged and reviewed.

4.12 Working with families after a death or serious injury

Purpose / when: a client's relative died or was seriously injured during or after restraint.
Steps: (1) Offer bereavement and trauma support without adjudicating fault. (2) Explain, in general terms, that in England deaths and serious injuries must be investigated thoroughly and transparently with family involvement, and independently. [source: gov.uk consultation response] (3) Help the family find legal and specialist support for inquests and investigations [uncertain: specific organisations not verified]. (4) Attend to anger, guilt and complicated grief over a long process. (5) Use safe-messaging if suicide is involved (no method detail).
Example language (illustrative): "You don't have to have the answers about what went wrong to be grieving now. Both can be here."
Watch for: prolonged grief, rumination, burnout from campaigning. Working: the family can grieve while pursuing the process at a sustainable pace.

4.13 Working with staff who have used restraint

Purpose / when: a client is a nurse, carer, teacher or support worker distressed by having restrained someone.
Steps: (1) Explore guilt, shame, fear and any injury to themselves. (2) Distinguish moral injury from clinical error. (3) Support reflection on their workplace culture and what they can raise (see 4.11). (4) If they disclose abuse by themselves or others, follow safeguarding duties. (5) Do not train, rehearse or critique physical techniques; refer technique questions to their employer's accredited trainers.
Example language (illustrative): "It sounds as though you did something your training required and it still feels wrong. Let's look at both."
Watch for: self-blame spirals, or defensive justification of practices that may be abusive. Working: clarity about responsibility and agency to act.

4.14 Using the history as a reflective lens

Purpose / when: in supervision, team reflection or teaching, to examine present-day coercion.
Steps: (1) Summarise the reform and its limits, attributed. (2) Draw the lesson historians' work suggests: abolishing one restraint can shift coercion elsewhere, as with seclusion in 1838–1844 (Topp 2018). (3) Ask which practices in your own setting might be today's equivalents (blanket restrictions, segregation, chemical restraint, as current guidance names them). (4) Agree one concrete change. [source: Topp 2018; NHS England; gov.uk]
Example language (illustrative): "The Victorians removed straps and argued about locked rooms. What are we not noticing here?"
Watch for: smugness about the past; reflection without action. Working: a named change is made and reviewed.

4.15 Attending to equality and discrimination

Purpose / when: a client from a group that experiences disproportionate force (the Act's guidance names protected characteristics; respondents highlighted autistic people, people with learning disabilities, children and Black and minority ethnic patients). [source: gov.uk consultation response]
Steps: (1) Ask directly whether the client believes their identity affected how they were treated. (2) Validate experiences of racism or ableism. (3) Adapt communication for autistic clients and clients with learning disabilities (plain language, sensory adjustments). (4) Include discrimination in complaints and advocacy where the client wishes.
Example language (illustrative): "Do you think who you are, your race, your disability, anything else, made a difference to how staff responded?"
Watch for: colour-blind or disability-blind dismissal. Working: the client feels their full experience is recognised.

4.16 Responding to romanticised or sensational heritage

Purpose / when: a client is distressed by, or drawn to, "haunted asylum" tours, horror media or nostalgic accounts of asylums.
Steps: (1) Explore the meaning: entertainment, fear, identification, grief for an ancestor. (2) Offer accurate history to counter caricature (reform, its limits, the patients as people). (3) Address stigma the media reinforce. (4) Support respectful forms of remembrance if the client wants them.
Example language (illustrative): "Those tours tell a story about monsters. The real history is about people, some of whom were helped and many of whom were not."
Watch for: media triggering memories of the client's own admissions. Working: less fear and stigma, more grounded understanding.

4.17 Supporting co-production and lived-experience involvement

Purpose / when: a client wants to turn their experience into change.
Steps: (1) Explore readiness and boundaries (what they will and will not share). (2) Signpost co-produced resources and involvement routes; NHS England notes easy-read and young people's resources co-produced with people with lived experience. [source: NHS England] (3) Plan self-care and debriefs around involvement. (4) Review whether involvement helps or harms.
Example language (illustrative): "You'd like your experience to help others. How much of your story do you want to keep private?"
Watch for: over-exposure, being used as a token. Working: involvement is meaningful and sustainable.

4.18 Advocacy in the therapist's own service

Purpose / when: you contribute to an inpatient or residential service.
Steps: (1) Contribute psychological formulations that explain distress and suggest less restrictive responses. (2) Support review of restrictive-intervention data by protected characteristic, which NHS England expects systems to do. [source: NHS England] (3) Encourage the use of patients' crisis preferences (4.8). (4) Stay within your role; do not design or teach physical interventions. [synthesis]
Example language (illustrative): "Her formulation suggests crowding and noise trigger her. Could we try a quieter space before anything else?"
Watch for: your input being used to justify restriction. Working: fewer restrictive incidents for the people you formulate.

5. Handling problems

The problems below are the psychotherapist's own synthesis [synthesis]; facts drawn from a cited source are attributed inline.

Stuck client (endless retelling of an incident or of asylum history). Name the pattern gently; ask what the retelling is trying to achieve (being believed, justice, warning others); move to one concrete action (complaint, crisis plan, letter not sent). [synthesis]
Mistrust of the therapist as part of "the system". Expect it. Clarify that you do not and will not use restraint, explain confidentiality limits openly, and offer choices in every session. Repair by asking what felt controlling. [synthesis]
Resistance to talking about restraint at all. Do not push. Work on present safety and coping; return to the topic only with consent. Avoidance of services may itself be a target, approached slowly. [synthesis]
Overwhelm or dissociation in session. Stop the narrative, ground in the present with the client's chosen method, reduce detail, and shorten the focus on trauma material. Never use touch to ground without consent before and during. [synthesis]
Suicide or self-harm risk. Restraint, seclusion and coercive admissions can be linked with despair and with avoidance of help. Assess risk directly using standard practice, plan safety including lethal-means counselling limited to safe storage and removal, and give crisis resources: 988 Suicide & Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). Follow safe-messaging principles: no method details, no glamorising. [synthesis]
Fear of readmission blocking help-seeking. Validate the fear; work on an advance plan (4.8) and on rights information (4.5); help the client identify a trusted contact in services. Do not advise on starting, stopping or changing any medicine; refer medication questions to the prescriber. [synthesis]
Non-adherence to agreed tasks (records request, complaint). Treat it as information: the task may be too exposing. Break it down, or set it aside. [synthesis]
Rupture: the client feels disbelieved. Acknowledge the impact, separate belief in their experience from questions about records, and apologise for what you contributed. [synthesis]
Conflicting accounts (client vs records). Hold both; records can omit or misdescribe. Victorian critics linked seclusion to a lack of transparency, and current law requires recording because practice was not always visible. [source: Topp 2018; gov.uk consultation response] Do not adjudicate; support the client to request explanations.
Over-idealising the reformers. Clients or colleagues may cite Conolly or Hill as proof that coercion can simply be abolished. Give the attributed caveats: abolition was gradual and contested, other measures continued, and seclusion became a substitute (Haw and Yorston 2004; Topp 2018). [source as named]
Ancestral shame and fear of heredity. Distinguish period beliefs from current understanding; refer for genetic counselling if the client has specific inherited-condition concerns. [synthesis]
Client is a child or young person. Use age-appropriate explanations; obtain parental consent and the young person's assent; follow child-protection routes for any disclosure of abusive restraint or seclusion; signpost young people's resources such as those NHS England describes. [source: NHS England for resources; rest synthesis]
Client is a current inpatient. Coordinate with the treating team only with consent; avoid encouraging confrontations that could escalate force; prioritise rights information and advocacy. [synthesis]
Requests for the therapist to endorse, teach or critique holds. Decline; restraint methods are never taught here. Refer to the employer's accredited training provider; in England, training must meet Restraint Reduction Network standards. [source: gov.uk consultation response]
Therapist's own reactions. Anger at services, or defensiveness if you have worked in them, can distort the work. Use supervision. [synthesis]

Sources

Web sources:

Books and texts cited:

Hill, R. G. [1839]. Total abolition of personal restraint in the treatment of the insane: a lecture on the management of lunatic asylums and the treatment of the insane, delivered at the Mechanics' Institution, Lincoln, on the 21st of June, 1838. London: Simpkin, Marshall and Co.
Conolly, J. 1856. The treatment of the insane without mechanical restraints. London: Smith, Elder & Co. (reissued Cambridge University Press, Cambridge Library Collection).

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