Non-restraint (Hill, Conolly)

Domain XVI · Historical, discredited & harmful · Robert Gardiner Hill, Edward Charlesworth, John Conolly · 1838 · Lincoln

What it is

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…

Format

• 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.
• 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.

Who practises it, and how they are trained or regulated

• 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…
• Advocacy and follow-up. Goal: support complaints, advance planning, involvement in co-production, and the therapist's own contribution to less coercive services.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• over-exposure, being used as a token. Working: involvement is meaningful and sustainable.
• smugness about the past; reflection without action. Working: a named change is made and reviewed.
• colour-blind or disability-blind dismissal. Working: the client feels their full experience is recognised.
• retaliation against you; normalisation ("that's how it's done here"). Working: concerns are logged and reviewed.
• your input being used to justify restriction. Working: fewer restrictive incidents for the people you formulate.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.