Positive Systems Approach

When Care Becomes Harm: Rethinking Isolation in Mental Health Treatment

A recent Toronto Star investigation (2025–2026) has raised serious concerns about the use of prolonged seclusion at Waypoint Centre for Mental Health Care. This investigation focused on patients—particularly those in forensic psychiatric care—being held in prolonged isolation (often termed “seclusion”) for extremely long periods, sometimes years or even decades. These conditions resemble solitary confinement, raising serious ethical and legal concerns. Some patients were reportedly kept in near-continuous seclusion for many years, with only brief breaks (“seclusion relief”). In one prominent case, a patient spent most of 20 years in isolation, with minimal therapeutic progress. The reporting highlights concerns that patients may become “stuck” in a system with little meaningful rehabilitation or pathway out. Although seclusion is supposed to be reviewed regularly, it seems that oversight mechanisms may not be sufficiently independent or effective. Courts have raised concerns about lack of independent assessments and inadequate treatment planning in long-term cases. Furthermore, the use of extended isolation is compared to solitary confinement practices criticized under international standards (e.g., UN Mandela Rules). These standards generally state isolation should be rare, short-term, and a last This article does an excellent job in framing the issue as a systemic tension in forensic mental health care. It highlights the risk that security-driven practices (like isolation) can override therapeutic goals and recommends the need for greater transparency, accountability, and external oversight.
In my opinion, the use of long term seclusion at the Waypoint Centre for Mental Health Care raises deeply troubling questions—not only about institutional practices, but about how we, as a society, understand and respond to human distress. The accounts of individuals held in prolonged seclusion for months, years, and in some cases decades, demand more than administrative review. They require a fundamental psychological and ethical reckoning.
From a clinical perspective, long-term isolation is not a neutral intervention. It is an experience that can fundamentally alter a person’s psychological functioning, often in ways that exacerbate the very behaviours it is meant to manage. Decades of research on solitary confinement and sensory deprivation show consistent patterns: heightened anxiety, depression, cognitive deterioration, emotional dysregulation, and in some cases, psychosis. When we apply these findings to individuals already living with significant mental health challenges, the implications become even more concerning.
Trauma provides a critical lens through which to understand this issue. Many individuals in forensic psychiatric settings have extensive trauma histories—childhood abuse, neglect, attachment disruptions, or chronic exposure to violence. Prolonged isolation can function as a re-traumatizing experience. It strips away predictability, connection, and safety—three elements that are essential for trauma recovery. Instead, the individual is placed in an environment characterized by deprivation, control, and often fear. This can lead to hyperarousal (heightened vigilance, aggression), dissociation, emotional numbing, or regression. What may be labeled as “non-compliance” or “aggression” in these contexts is often better understood as trauma-driven survival responses.
Cognitively, isolation has profound effects. Human cognition is inherently social; our ability to think clearly, regulate emotions, and make decisions is supported by interaction and environmental stimulation. Extended seclusion reduces sensory input and social feedback, leading to impairments in attention, memory, and executive functioning. Individuals may become less capable of engaging in treatment, not more. In this way, isolation undermines the very rehabilitation goals that forensic psychiatric systems are meant to uphold.
Behaviourally, the reliance on isolation reflects a model rooted in control and suppression. From a behavioural science standpoint, this is problematic. When behaviour is suppressed without understanding its function, the underlying drivers remain intact. In many cases, behaviours escalate, generalize, or are replaced by new maladaptive patterns. Moreover, as outlined in the book written by myself and Terry Kirkpatrick, Managing Disruptive Behaviour with a Positive Systems Approach, punishment-based strategies—even when effective in the short term—are associated with significant negative side effects, including fear, avoidance, and damage to the therapeutic relationship . These outcomes are not incidental; they are predictable.
This is where the contrast with the Positive Systems Approach (PSA) becomes especially stark.
PSA begins from a fundamentally different premise: that behaviour is communication, and that our role is to understand—not suppress—it. Rather than asking, “How do we stop this behaviour?”, PSA asks, “What is this behaviour telling us about unmet needs, environmental stressors, or skill deficits?” This shift is not merely semantic; it transforms the entire intervention framework.
In the context of the situations described in the Toronto Star article, PSA would reject prolonged isolation as both ineffective and ethically problematic. Instead, it would prioritize a comprehensive functional assessment—examining antecedents, consequences, trauma history, cognitive capacity, and systemic influences. As emphasized in our book, behaviour does not occur in a vacuum; it emerges from the dynamic interaction between the individual and their environment . When we change the environment, we often change the behaviour.
A Positive Systems Approach would focus first on creating conditions of safety and predictability. This includes consistent and sufficient staffing, reduced exposure to triggering environments, and the development of trusting relationships. The importance of rapport cannot be overstated. Individuals who have experienced chronic trauma or institutionalization often struggle with attachment and trust. Placing them in isolation only reinforces these difficulties, whereas PSA explicitly targets relationship-building as a core therapeutic mechanism.
Second, PSA emphasizes teaching alternative skills rather than suppressing behaviour. If an individual becomes aggressive when overwhelmed, the intervention is not to isolate them, but to help them recognize early signs of distress and develop coping strategies—whether through communication supports, sensory regulation, or structured routines. This aligns with the broader psychological literature on skill acquisition and emotional regulation.
Third, PSA addresses system-level factors. The Toronto Star article implicitly highlights systemic failures: lack of individualized planning, insufficient oversight, and environments that prioritize risk management over rehabilitation. PSA directly confronts these issues by examining factors such as staffing consistency, training, environmental design, and organizational culture. It recognizes that “challenging behaviour” is often as much a product of system dysfunction as individual pathology.
Finally, PSA is grounded in a clear ethical stance: the least restrictive, most humane intervention should always be the goal. Prolonged isolation fails this standard. It is not only restrictive; it is dehumanizing. When individuals are deprived of meaningful interaction, autonomy, and stimulation for extended periods, we must be willing to call this what it is—an abusive practice, regardless of the intentions behind it.
The broader lesson from the Waypoint case is not simply that reforms are needed within a single institution. It is that we must critically examine the underlying models that guide our responses to behavioural and mental health challenges. Approaches rooted in control, containment, and suppression will continue to produce these outcomes. In contrast, approaches grounded in understanding, relationship, and systemic change—such as the Positive Systems Approach—offer a pathway toward more effective and humane care.
If we are serious about rehabilitation, recovery, and dignity, then the question is not whether we can reduce reliance on isolation. The question is why we have relied on it for so long, despite what we know clinically, psychologically, and ethically about its harms. The evidence is clear. The alternatives exist. What remains is the will to change.

Latest book - What if it's Not Just the Behaviour (Amazon) outlining how to use Positive Systems Approach in parenting. Positive Systems Approach offers a strengths-based and person-centered approach to behaviour change, focusing on promoting positive outcomes, enhancing quality of life, and fostering meaningful participation in society. By emphasizing positive reinforcement, detailed functional assessments, proactive strategies focusing on prevention, collaboration, and cultural sensitivity, Positive Systems Approach seeks to empower vulnerable individuals, many of whom present with developmental disabilities, autism, other neurodivergent presentations, or are dually diagnosed with mental health disorders, promoting their overall well-being by building effective positive systems for managing and preventing behavioural issues.

What if the behaviour you’re seeing in children isn’t the real problem?

As a psychologist, I’ve worked with countless children and families who are told to focus on “fixing behaviour.”

But behaviour is often just the surface—not the cause.
In What if it’s Not Just the Behaviour?, I explore what’s really underneath: attention differences, processing challenges, emotional regulation, and the hidden factors that shape how kids function day to day.

But here’s something many people don’t realize 👇

On my website, drbobcarey.com, there are now 100+ blog posts filled with practical, evidence-informed insights—and they’re completely free.

These aren’t just general ideas. They’re grounded in real clinical work and designed to help you actually understand and support kids more effectively.

Recent posts explore topics like:
• Why “not trying” is often misunderstood effort and cognitive overload
• The hidden role of working memory in school struggles
• Emotional regulation vs. behaviour management—why they’re not the same
• Why traditional consequences often don’t work for neurodivergent learners
• How to better interpret shutdowns, avoidance, and frustration

Many posts also include tools, strategies, and excerpts from my book that you can start using right away.
👉 Start exploring here: drbobcarey.com/blog

📘 And if this perspective resonates, check out What if it’s Not Just the Behaviour?

Because when we understand the why, everything changes.

Understanding Dual Diagnosis in Developmental Disabilities and the Role of Positive Systems Approach

Read the blog post here:

Understanding Dual Diagnosis in Developmental Disabilities and the Role of Positive Systems Approach What is Dual Diagnosis in the Developmental Disability Field?In the Developmental Disability field, dual diagnosis refers to the co-occurrence of a developmental disability (DD) and a mental health disorder in an individual. Unlike other medical or psychiatric conditions that may exist separately, d...

Dependent Personality Disorder and Developmental Disability: Be Aware of Over Pathologizing Help Seeking Behaviours.

Read the blog post here:

Dependent Personality Disorder and Developmental Disability: Be Aware of Over Pathologizing Help Seeking Behaviours. Dependent Personality Disorder (DPD) is characterized by an excessive need to be taken care of, leading to submissive and clinging behaviors, and fears of separation. Individuals with DPD often struggle with making decisions independently, require constant reassurance, and may go to great lengths to...

Attachment Disorder and Developmental Disabilities: Understanding, Treatment, and the Positive Systems Approach

Read the blog post here:

Attachment Disorder and Developmental Disabilities: Understanding, Treatment, and the Positive Systems Approach IntroductionAttachment disorder is a complex and often misunderstood condition that can significantly impact individuals with developmental disabilities. Early disruptions in caregiver relationships, trauma, or neglect can lead to attachment difficulties, which in turn affect emotional regulation, s...

The Role of Positive Reinforcement and Contingency Management in Positive Systems Approach (PSA)

Read the blog post here:

The Role of Positive Reinforcement and Contingency Management in Positive Systems Approach (PSA) Positive reinforcement is a cornerstone of the Positive Systems Approach (PSA), a methodology designed to manage disruptive behaviours by fostering human connection and trust. By providing frequent, non-contingent positive interactions (see previous Blog post of Aug. 19 =, 2024; Positive Systems), c...

"Choice Distress" - a few Ways to Avoid Creating This

Read the blog post here:

"Choice Distress" - a few Ways to Avoid Creating This What stimulated me to write this blog today was a show on CBC Radio1 about residents of nursing homes, specifically those with dementia, and something called the "Butterfly Model" of care (https://fco.ngo/files/Resource-Spotlight-Butterfly-Model-1.pdf). A specific example of a discussion between an....

A Compassionate Approach to Addressing Self-Injurious Behaviour Using Positive Systems Approach

Read the blog post here:

A Compassionate Approach to Addressing Self-Injurious Behaviour Using Positive Systems Approach Self-injurious behaviour (SIB) is unfortunately prevalent among individuals with developmental disabilities, though exact figures can vary widely depending on the specific disability and the population studied. Generally, it's estimated that anywhere from 10% to 17% of individuals with developmental...

A Safer, Smarter Approach: Managing Aggressive Behaviours in Neurodivergent and Developmentally Disabled Individuals

Read the blog post here:

A Safer, Smarter Approach: Managing Aggressive Behaviours in Neurodivergent and Developmentally Disabled Individuals Supporting neurodivergent and developmentally disabled individuals who exhibit severe aggression presents multifaceted challenges for families and support staff. These challenges encompass physical safety concerns, emotional and psychological stress, social isolation, financial burdens, and systemic...