Title 25. HEALTH SERVICES
Part II. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL 
RETARDATION
Chapter 405. CLIENT (PATIENT) CARE
Subchapter F. RESTRAINT AND SECLUSION
§ 405.131 Exhibits

(a) Exhibit A, titled "Acceptable Mechanical Restraints," describes the types of mechanical restraints that may be 
used by the department facilities. 
(1) Anklets--A cloth or leather band fastened around the ankle or leg and secured to a stationary object (e.g., bed or 
chair frame). Acceptable fasteners include velcro and buckle-type devices. The device must not be secured so tightly 
as to interfere with circulation nor so loose as to permit chafing of the skin. Padding on the inside of the device aids 
in preventing chafing. 
(2) Arm Splints--Strips of plaster of paris, wood, or plastic which extend from below to above the elbow. They are 
secured around the arm with velcro tabs or ties. If appropriate, they should be secured such that the client has full 
use of the hands. The device must not be secured so tightly as to interfere with circulation nor so loose as to permit 
chafing of the skin. Padding on the inside of the device aids in preventing chafing. These devices are also referred to 
as elbow immobilizers. 
(3) Belts--A cloth or leather band fastened around the waist. The belt may either be attached itself to a stationary 
object (e.g., chair frame) or used for securing the arms to the sides of the body. The device must not be secured so 
tightly as to interfere with circulation. 
(4) Camisole--A sleeveless cloth jacket which covers the arms and upper trunk. The device is secured with strings 
which are tied behind the client's back. The device must not be secured so tightly as to interfere with circulation or 
cause muscle strain. Caution should be exercised in the use of this device since it may impair balance and the client's 
ability to break a fall. 
(5) Chair Restraint--A well-padded stabilized chair which supports all body parts and prevents voluntary removal 
from the chair without assistance (e.g. , table top chair, luminex chair). Mechanical restraint devices (e.g., wristlets, 
anklets) are attached or may be easily attached to restrict client movement. The devices must not be secured so 
tightly as to interfere with circulation or other vital functions. 
(6) Enclosed Bed--A bed with high side rails or other type of side enclosure and, in some cases, an enclosure (mesh, 
rails, etc.) on the top of the bed. Such a bed is considered a restraint device if the client's voluntary egress is 
prevented. 
(7) Helmets--A plastic, foam rubber, or leather head covering. The various types of sport helmets belong to this 
category of restraint devices. If appropriate, a face guard may be attached to the helmet. The device must be proper 
size for the client, and the chin strap should not be so tight as to interfere with circulation. 
(8) Mittens--A cloth, plastic, foam rubber, or leather hand covering fastened around the wrist or lower arm. Boxing 
and other types of sport gloves belong to this category of restraint devices, as do socks and stockings. Acceptable 
fasteners include elastic, velcro, ties, paper tape, safety pins, pull strings, buttons, and snaps. The device must not be 
secured so tightly as to interfere with circulation. 
(9) Restraining Net--Mesh fabric (e.g., posey restraining net) over the upper and lower trunk of the body, with head, 
arms and lower legs exposed, secured over a mattress to a bed frame. The restraining net must be loose enough to 
allow the client some movement. Under no conditions shall this net be placed over the client's head. The device 
must not be secured so tightly as to interfere with breathing, circulation or other vital functions. 
(10) Restraint Board--An upholstered, rigid board to which is attached several closing canvas flaps with velcro 
fasteners. These flaps are folded across a person's body in a criss-cross fashion. A strap designed to go across the 
forehead is also a common feature. The device is intended for use only when the person is in a prone position. The 
device is also referred to as a Papoose Board. 
(11) Straight Jacket--A heavy canvas jacket with sleeves that are stitched together such that the client's arms are 
crossed at the front of the body. The device is secured with strings which are tied behind the client's back. The 
device must not be secured so tightly as to interfere with circulation or cause muscle strain. Caution should be 
exercised in the use of this device since it may impair balance and the client's ability to break a fall. 
(12) Ties--A length of cloth or leather used to secure approved mechanical restraints (i.e., mittens, wristlets, arm 
splints, belts, anklets, vests, etc.) to a stationary object (i.e., bed or wheelchair frame) or to other mechanical 
restraints. Ties must not be secured so tightly as to interfere with circulation. Ties may only be used with acceptable 
mechanical restraints. 
(13) Transport Jacket--A heavy canvas sleeveless jacket which encases the arms and upper trunk. It is fastened with 
velcro closures and roller buckles and held in place with a strap between the legs. The device should be used only as 
a temporary measure. 
(14) Vest--A sleeveless cloth jacket which covers the upper trunk of the client. The vest is fastened in the back or 
front with ties or velcro. The vest may be secured to a stationary object (e.g., bed or chair frame). The vest and ties 
must not be secured so tightly as to interfere with breathing, circulation, or vital functions. 
(15) Wristlets--A cloth or leather band fastened around the wrist or arm and secured to a stationary object (e.g., bed 
or chair frame, waist belt). Acceptable fasteners include velcro and buckle-type devices. The device must not be 
secured so tightly as to interfere with circulation nor so loose as to permit chafing of the skin. Padding on the inside 
of the device aids in preventing chafing. 
(b) Exhibit B, titled "Unacceptable Mechanical Restraints" describes the types of mechanical restraints that may not 
be used by the department facilities. 
(1) Metal wrist or ankle cuffs. 
(2) Rubber bands as fastening devices. 
(3) Rope or cord as fastening devices. 
(4) Long ties (e.g., "leashes"). 
(5) Restraining sheets. 
(6) Padlocks or key locks. 
(7) Restraining a client in a standing position to a stationary object. 
(c) Exhibit C, titled "Daily Summary of Restraints and Seclusion" is an example of a log which may be used to 
communicate the use of restraint and seclusion through administrative channels. 
T25S405.131(c) 
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Source: The provisions of this § 405.131 adopted to be effective August 20, 1984, 9 TexReg 4288.
Cross Reference: This Section cited in 25 TAC § 405.124, (relating to Policy Governing Use of Restraint or 
Seclusion); 25 TAC § 405.125, (relating to Procedures Required to Initiate and Monitor Personal Restraint); 25 TAC 
§ 405.126, (relating to Procedures Required to Initiate and Monitor Mechanical Restraint); 25 TAC § 405.127, 
(relating to Procedures Required to Initiate and Monitor Seclusion).