Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Open Forum   |    
Seclusion and Restraint as Measures of the Quality of Hospital Care: Any Exceptions?
Michael H. Sacks, M.D.; Michael F. Walton, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300577
View Author and Article Information

Dr. Sacks is with the Department of Psychiatry, New York–Presbyterian Hospital, New York City. Dr. Walton is with the Department of Psychiatry, NYU Langone Medical Center, New York University, New York City. Send correspondence to Dr. Walton (e-mail: michael.walton@nyumc.org).

Copyright © 2014 by the American Psychiatric Association


The Joint Commission has recently included seclusion and restraint as quality-of-care indicators for hospital-based inpatient psychiatric services. Their inclusion is the result of abuse of these practices, wide variation across hospitals, and cultural influences, including the consumer and recovery movements. Over the next few years, these indicators will increasingly influence treatment modalities available to hospitalized patients. This Open Forum provides a brief history of changing attitudes toward use of seclusion and restraint. It describes three clinical scenarios that highlight appropriate and humane use of seclusion and restraint and that illustrate the clinical complexities associated with their use. Potential unforeseen consequences of the reduction or elimination of seclusion and restraint are described.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).



Specifications Manual for Joint Commission National Quality Measures (v2014A).  Oakbrook Terrace, Ill,  The Joint Commission, 2013. Available at manual.jointcommission.org/releases/TJC2014A/MIF0117.html. Accessed Dec 23, 2013
QualityNet: Hospital Value-Based Purchasing Overview. Baltimore, Center for Medicare and Medicaid Services. Available at www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetBasic&cid=1228772039937. Accessed Dec 23, 2013
Weiss E: Deadly restraint: a nationwide pattern of death. Hartford (Conn) Courant, p A1, Oct 11, 1998
Fisher  WA:  Restraint and seclusion: a review of the literature.  American Journal of Psychiatry 151:1584–1591, 1994
Busch  AB;  Shore  MF:  Seclusion and restraint: a review of recent literature.  Harvard Review of Psychiatry 8:261–270, 2000
[CrossRef] | [PubMed]
Tomes  N:  The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health.  Health Affairs 25:720–729, 2006
[CrossRef] | [PubMed]
Barber  ME:  Recovery as the new medical model for psychiatry.  Psychiatric Services 63:277–279, 2012
[CrossRef] | [PubMed]
Curie  CG:  SAMHSA’s commitment to eliminating the use of seclusion and restraint.  Psychiatric Services 56:1139–1140, 2005
[CrossRef] | [PubMed]
LeBel  J:  Regulatory change: a pathway to eliminating seclusion and restraint or “regulatory scotoma”? Psychiatric Services 59:194–196, 2008
[CrossRef] | [PubMed]
Davidson  L:  Use of coercion in recovery-oriented care: staying vigilant.  Psychiatric Services 63:834, 2012
[CrossRef] | [PubMed]
Lieberman  J:  Elimination of seclusion and restraint: a reasonable goal?[letter]  Psychiatric Services 57:576, 2006
Sharfstein  SS:  Commentary: reducing restraint and seclusion: a view from the trenches.  Psychiatric Services 59:197–198, 2008
[CrossRef] | [PubMed]
Geller  JL:  Patient-centered, recovery-oriented psychiatric care and treatment are not always voluntary.  Psychiatric Services 63:493–495, 2012
Larue  C;  Dumais  A;  Boyer  R  et al:  The experience of seclusion and restraint in psychiatric settings: perspectives of patients.  Issues in Mental Health Nursing 34:317–324, 2013
[CrossRef] | [PubMed]
References Container

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 41.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 39.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 39.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 62.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 62.  >
Topic Collections
Psychiatric News
PubMed Articles