The use of restraint was eliminated in psychiatric hospitals 200 Years ago: Why are we still using coercive practices?

In 1838, the Mechanic's Hospital in Lincoln, England announced they had eliminated the use of restraint with all residents using Moral Treatment. This methodology of meeting the needs of people affected by mental health concerns utilizing peer supports, robust data analysis and listening to the patient's perspective without using restraint or seclusion spread to other parts of Europe and North America, leading to the emancipation of people from the chains of mental health treatment. However, beginning in the last part of the 19th century, the chains came back into use in the form of physical and manual restraints as well as living in abusive and neglectful environments. Almost 200 years later the broad field of mental health and disability services is again finding ways to eliminate the use of restraint and other coercive practices through Trauma Informed Behavior Supports (TIBS), and the leadership of organizations such as the American Psychiatric Nurses Association (APNA), the British Institute for Learning Disabilities (BILD) and others. The questions are: Why did restraint and other coercive practices emerge after their use had been eliminated, and what factors which led to their re-emergence are present in the 21st century and may threaten the progress made in the elimination of restraint and seclusion at this point in time? This paper will examine the points of transition between non-coercive and coercive practices and how the policies and cultural factors that led to the demise of Moral Treatment may also lead to the demise of TIBS and gives policy recommendations to prevent this from occurring.