Seclusion and restraint are increasingly controversial, and with good reason. Acutely aggressive patients can pose a risk to themselves, other patients, and staff. But we also know that seclusion and restraint can be deadly. However, no medical literature guides us as to which methods are safer and under which circumstances. We also know that patients have described these experiences as negative at best, and as traumatic at worst. Of further concern, seclusion and restraint are not applied uniformly—numerous studies have shown considerable variation in their frequency and duration. Nonclinical factors, such as patients' ethnicity and level of staff experience, are known to be associated with the use of seclusion and restraint. Tellingly, quality improvement programs aimed at reducing seclusion and restraint have been successful, without increased risk to patients or staff. Indeed, some programs have seen reductions in such injury.