Seclusion or Restraint
This resource document is intended to support psychiatrists and other healthcare clinicians who may utilize seclusion or restraint. This document is not intended to be comprehensive or completely systematic in nature, nor is it a practice guideline. It is highly recommended that all providers consult with their facility/practice administrator, risk manager, and legal counsel as well as local, state, and federal regulations as it pertains to the use of seclusion or restraint, especially in special populations.
Seclusion or restraint (S/R) is used as an intervention of last resort in the management of severe agitation in patients. These interventions carry considerable risks including, but not limited to, psychological distress, physical injury to the patient or staff, and/or death. Legally, S/R can only be used in emergency safety situations and only when all lesser restrictive interventions have been attempted, in order to prevent immediate harm to a patient or others. An extensive literature exists regarding the fundamental goal of providing psychiatric care that helps to avoid the use of S/R. Clinicians often have a limited understanding of the potential risks of each intervention. A framework for determining when to use either modality is a critical clinical concern.
In this resource document, the PSWG of the APA Council on Quality Care outlines a set of practical considerations for using S/R and provides resources to increase awareness and highlight areas of importance for psychiatrists and other mental health care clinicians, who are providing psychiatric care for adults in emergency and hospital settings.