Reducing Restraint in Mental Health Facilities in Texas

Texas Title 25, Chapter 41 is intended to help mental health facilities in Texas ensure that staff have the skills to handle agitated and violent behavior in a way that’s as safe as possible for everyone.

The new section to Title 25 415 of the Texas Administrative Code (TAC), Chapter 415.251–415.276, is designed to help reduce the use of restraint and seclusion in mental health facilities in Texas. The section incorporates the Centers for Medicare and Medicaid Services Conditions of Participation terminology concerning the use of restraint and seclusion for managing both violent, self-destructive behavior and nonviolent, non-self-destructive behavior. It emphasizes the need to ensure that, whenever possible:

• Staff use alternatives to restraint.
• Staff use the least restrictive methods of intervention.
• Seclusion and restraint are used only as a last resort.

Under section 415.254, a facility is prohibited from using restraint and seclusion unless it: 

• Develops, implements, and enforces written policies and procedures on best practices.
• Implements a staff training program that requires staff to demonstrate competence before assuming direct-care duties and before using restraint or seclusion.
• Requires that training be conducted at least annually after a staff member’s initial training.

The section stipulates that the training programs implemented by facilities that are affected by this regulation incorporate evidence-based best practices and be evaluated annually. It also prohibits prone and supine positions and requires that if an individual becomes prone or supine during a restraint, staff administering the restraint will immediately transition the individual to a side-lying or other position that is considered safer than a prone or supine position.

We Can Help You Comply With the Regulation!
Facilities around the globe use our Nonviolent Crisis Intervention^® training program because it helps staff deepen their person-centered, trauma-informed approach to care. CPI training focuses on prevention and de-escalation techniques that help staff understand the roots of aggressive and violent behavior, and control their own responses to the behavior. The course also equips staff with techniques for using safer, less-restrictive physical interventions only as a last resort. Additionally, the training helps staff interact effectively and empathically with individuals who have experienced trauma.

Tailoring Training to Your Facility’s Needs
Our training can be tailored to the unique needs of your facility, staff, and patients. With our train-the-trainer option, select staff can be certified to teach the program to other staff on a continuing basis.

We have several public programs coming to Texas, and an on-site training option is also available.

Additional Resources

• Get helpful hints for crisis intervention.
• Learn more about restraint reduction and CPI training.
• Access resources for providing trauma-informed care.