People under suicide watch are put into an environment where it would be difficult for them to hurt themselves. In many cases, any dangerous items will be removed from the area, such as sharp objects and some furniture, or they may be placed in a special padded cell, which has nothing outcropping from the walls (e.g., a clothes hook or door closing bracket) to provide a place for a ligature to be attached, and with only a drain-grill on the floor. They may be stripped of anything with which they might hurt themselves or use as a noose, including shoelaces, belts, neckties,[1] bras, shoes, socks, suspenders and bed sheets.[2] In extreme cases the inmate may be undressed entirely.
In even more extreme cases, inmates may be placed in "therapeutic restraints", a four- or five-point restraint system. The inmate is placed on their back on a mattress. Their arms and legs are tied down and a belt is placed across the chest. In a five-point system the head is also restrained. An inmate is allowed a range of movement every two hours, when one limb is released and they are allowed to move it for a short period. They are then restrained again, proceeding to the next limb. This process is repeated until all areas restrained have been moved. This process usually continues in eight-hour shifts, and the inmate has a face-to-face encounter with a mental health professional at least once in each eight-hour interval. This cannot continue for more than 16 consecutive hours. The inmate is continually watched by staff during this time.
In the most extreme cases of self-harm, only when all other avenues have not worked or are impracticable,[citation needed] "chemical restraint" drugs may be used to sedate the inmate. In order for a facility to administer a chemical restraint, it must have the approval/recommendation of a licensed mental health professional, the facility warden, and a court order