Use and Avoidance of Seclusion and Restraint: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup
Open accessAbstract
Issues surrounding reduction and/or elimination of episodes of seclusion and restraint for patients with behavioral problems in crisis clinics, emergency departments, inpatient psychiatric units, and specialized psychiatric emergency services continue to be an area of concern and debate among mental health clinicians. An important underlying principle of Project BETA (Best practices in Evaluation and Treatment of Agitation) is noncoercive de-escalation as the intervention of choice in the management of acute agitation and threatening behavior. In this article, the authors discuss several aspects of seclusion and restraint, including review of the Centers for Medicare and Medicaid Services guidelines regulating their use in medical behavioral settings, negative consequences of this intervention to patients and staff, and a review of quality improvement and risk management strategies that have been effective in decreasing their use in various treatment settings. An algorithm designed to help the clinician determine when seclusion or restraint is most appropriate is introduced. The authors conclude that the specialized psychiatric emergency services and emergency departments, because of their treatment primarily of acute patients, may not be able to entirely eliminate the use of seclusion and restraint events, but these programs can adopt strategies to reduce the utilization rate of these interventions.
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The use of seclusion and restraint varies drastically between services, jurisdictions and countries, with up to 300-fold differences in the rate of use found in one review.
“The use of seclusion and restraint also varies drastically between services, jurisdictions and countries, with up to 300-fold differences in the rate of use found in one review (91).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [91]
The Use of Physical Restraint section reports that restraint use is significantly higher in emergency departments than in inpatient facilities, supporting variation between services. It does not report comparisons between jurisdictions or countries, or a review finding up to 300-fold differences in rates. (LLM, conf=0.86)
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- Authors
- Knox, D., & Holloman, G.
- Affiliations
- University of Mississippi Medical Center (US)
- Venue
- Western Journal of Emergency Medicine
- Published
- 2012-02-01
- Volume
- 13
- Issue
- 1
- Pages
- 35-40
- ISSN
- 1936-900X (ISSN-L)
- 1936-9018
- PMC
- PMC3298214
- OpenAlex
- W2125055618
- Cited by
- 234
- References
- 29
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 16 · 2023: 21 · 2022: 20 · 2021: 23 · 2020: 20 · 2019: 16 · 2018: 13 · 2017: 22 · 2016: 18 · 2015: 18 · 2014: 6 · 2013: 11 · 2012: 3
- FWCI
- 13.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Western Journal of Emergency Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
- Keywords
- seclusion, physical restraint, de-escalation, acute agitation, psychiatric emergency care, emergency department, psychiatric ward, quality improvement, risk management, coercion in mental health care
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