To the Editor: As chairperson of the American Psychiatric Association's committee in patient safety, I applaud the inclusion of the articles on seclusion and restraint in the September issue of Psychiatric Services (1,2,3,4,5). The safe and minimal use of seclusion and restraint is one of the committee's first three initiatives. Reading these articles makes one realize that this particular patient safety goal is well on its way to being achieved.
However, I would also argue that, for most acute psychiatric settings, total elimination of seclusion and restraint is not a practical goal unless one puts dogma ahead of both patient safety and staff safety. Rather, I would argue that the goal should be safe, judicious, and minimal use of seclusion and restraint.
Dr. Herzog is vice-president of medical affairs at Hartford Hospital in Hartford, Connecticut, and professor of clinical psychiatry at the University of Connecticut School of Medicine in Farmington.
1. Donat DC: Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. Psychiatric Services 56:1105–1108,2005Link, Google Scholar
2. LeBel J, Goldstein R: The economic cost of using restraint and the value added by restraint reduction or elimination. Psychiatric Services 56:1109–1114,2005Link, Google Scholar
3. Smith GM, Davis RH, Bixler EO, et al: Pennsylvania state hospital system's seclusion and restraint reduction program. Psychiatric Services 56:1115–1122,2005Link, Google Scholar
4. Frueh BC, Knapp RG, Cusack KJ, et al: Patients' reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services 56:1123–1133,2005Link, Google Scholar
5. Robins CS, Sauvageot JA, Cusack KJ, et al: Consumers' perceptions of negative experiences and "sanctuary harm" in psychiatric settings. Psychiatric Services 56:1134–1138,2005Link, Google Scholar
