Fact Sheet Seclusion (revised)
from Equip for Equality’s Legal Advocacy Program
EFE FACT SHEET – Mental HealthSECLUSION IN A MENTAL HEALTH FACILITY IN ILLINOIS
Statutory References: 405 ILCS 5/1-126; 5/2-109; and the Center for Medicare and Medicaid Services (CMS) Rules
What is Seclusion
Seclusion means placing a person with a disability alone in a room that he or she cannot leave. A person with a disability is the person receiving mental health services, such as a person in a state mental health facility, in a private psychiatric hospital, or in the emergency room or psychiatric wing of a general hospital.
What is not Seclusion
Restricting a person to a given area or room as part of a behavior modification program which has been authorized as part of his or her treatment plan is not considered seclusion, provided that the restriction does not last longer than two hours at a time nor longer than a total of four hours in any twenty-four hour period and the length of time, type of restriction, and the purposes for the restriction are promptly documented in his or her record.
Use of Seclusion
Seclusion may be used only in emergency situations to prevent a person with a disability from causing physical harm to himself or herself or physical abuse to others. Seclusion is never to be used as punishment, discipline, or as a convenience for the staff.
Seclusion by Written Order
Seclusion is to be used only upon the written order of a physician, clinical psychologist, clinical social worker, or registered nurse with supervisory responsibilities.
To order seclusion a physician, clinical psychologist, clinical social worker, or registered nurse with supervisory responsibilities must personally observe and examine the person with a disability and from this observation, be clinically satisfied that the use of seclusion is justified to prevent the person with a disability from causing physical harm to himself or herself or others.
What must be in an Order for Seclusion
An order for seclusion must state the events leading up to the need for seclusion and the purposes for which seclusion is employed. The order must also state the length of time seclusion is to be employed and the clinical justification for that length of time. A PRN (as needed) or standing orders are prohibited as authorization for the use of seclusion.
Length of Time in Seclusion
Seclusion may not last longer than 2 hours unless within that time period a nurse with supervisory responsibilitites or a physician confirms in writing , following a personal examination of the person in seclusion, that seclusion does not pose an undue risk to the person’s health given his or her physical or medical condition.
At the end of the initial time period, if further seclusion is required a new order must be written which complies with the requirements for the initial order for seclusion. No order for seclusion shall be valid for more than 16 hours.
Seclusion may be employed during all or part of one 16-hour period that begins with the initial application of the seclusion. However, once seclusion has been employed during one 16-hour period, it cannot be used again on the same person with a disability during the next 48 hours without written authorization from the facility director.
Qualified personnel must check on a person with a disability who is in restraints and in seclusion at least once every 15 minutes and maintain a record of these observations.
Review of Seclusion Orders by Facility Director
The person ordering the use of seclusion must notify the facility director within 24 hours and the facility director must review all seclusion orders daily and question any person who routinely orders them.
Safety Precautions
Safety precautions must be followed to prevent injuries to the person with a disability in the seclusion room, which must be adequately lighted, heated, and furnished. If a door is locked, someone with a key must be in constant attendance nearby.
Notification of Others of Seclusion
Whenever seclusion is used, the person with a disability must be advised of his or her right to have any person of his or her choosing notified, including the Guardianship and Advocacy Commission or Equip for Equality. A person with a disability who has a guardian may request notification to others whether or not his or her guardian approves. Whenever the Guardianship and Advocacy Commission is notified that a person with a disability has been secluded, it must contact that person with a disability to determine the circumstances of the seclusion and whether further action is warranted.
Report of Deaths
If a facility receives Mediare or Medicaid funding, the facility director must report to CMS (Center for Medicare and Medicaid Services) any death that occurs when a person is being held in seclusion or where it is reasonable to assume that the death was the result of being in seclusion. The report of a death must be made during the next business day following the death.
DO YOU HAVE A QUESTION?
Contact Equip for Equality (all services are free of charge):
800.537.2532 (voice) or 800.610.2779 (TTY)
This resource material is intended as a guide for people with disabilities. Nothing written here shall be understood to be legal advice. For specific legal advice, an attorney should be consulted.
Equip for Equality, an independent nonprofit organization, is the Illinois state Protection & Advocacy System whose mission is to advance the human and civil rights of children and adults with disabilities.
This publication was made possible by a grant from the Center for Mental Health Services. The contents of this publication are the sole responsibility of the authors and do not represent the official views of the Center for Mental Health Services.
©Equip for Equality, 2005Revised: Revised: 06/01/2006
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