The DOI matches its Crossref record; 29 of the 29 references it cites were found in a registry or an index.
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 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]
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Frueh, B. C., Knapp, R. G., Cusack, K., Grubaugh, A. L., Sauvageot, J. A., Cousins, V. C., Yim, E., Robins, C. S., Monnier, J., & Hiers, T. G. (2005) · Psychiatric Services · doi:10.1176/appi.ps.56.9.1123 · Cited by 545
Restraint and seclusion: a review of the literature
Fisher, W. A. (1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.11.1584 · Cited by 454
Adverse Effects Associated with Physical Restraint
Mohr, W. K., Petti, T. A., & Mohr, B. D. (2003) · The Canadian Journal of Psychiatry · doi:10.1177/070674370304800509 · Cited by 369
Violence against emergency department workers
GATES, D. M., Ross, C. S., & McQueen, L. (2006) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2005.12.028 · Cited by 290
Smith, G. M., Davis, R. H., Bixler, E. O., Lin, H.-M., Altenor, A., Altenor, R. J., Hardentstine, B. D., & Kopchick, G. A. (2005) · Psychiatric Services · doi:10.1176/appi.ps.56.9.1115 · Cited by 273
Overview of Project BETA: Best practices in Evaluation and Treatment of Agitation
Holloman, G., & Zeller, S. (2012) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2011.9.6865 · Cited by 188
Self-citationDonat, D. C. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.8.1119 · Cited by 128
Eliminating Seclusion and Restraint in Recovery-Oriented Crisis Services
Ashcraft, L., & Anthony, W. A. (2008) · Psychiatric Services · doi:10.1176/ps.2008.59.10.1198 · Cited by 120
Borckardt, J. J., Madan, A., Grubaugh, A. L., Danielson, C. K., Pelic, C., HARDESTY, S. J., Hanson, R. F., Herbert, J. M., Cooney, H., Benson, A. R., et al. (2011) · Psychiatric Services · doi:10.1176/ps.62.5.pss6205_0477 · Cited by 117
A prospective study of the complication rate of use of patient restraint in the emergency department
Zun, L. S. (2003) · Journal of Emergency Medicine · doi:10.1016/s0736-4679(02)00738-2 · Cited by 111
Cited by
Sorted by citations
Assessment and management of agitation in psychiatry: Expert consensus
Garriga, M., Pacchiarotti, I., Kasper, S. F., Zeller, S. L., Allen, M. H., Vázquez, G. H., Baldaçara, L., San, L., McAllister-Williams, H., Fountoulakis, K. Ν., et al. (2016) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1132007 · Cited by 331
Nordstrom, K., Berlin, J. S., Nash, S. S., Shah, S. B., Schmelzer, N. A., & Worley, L. L. M. (2019) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2019.6.42422 · Cited by 136
Roppolo, L. P., Morris, D. W., Khan, F., Downs, R., Metzger, J., Carder, T., Wong, A. H., & Wilson, M. P. (2020) · JACEP Open · doi:10.1002/emp2.12138 · Cited by 130
Experiences of Individuals Who Were Physically Restrained in the Emergency Department
Wong, A. H.-W., Ray, J. M., Rosenberg, A. P., Crispino, L. J., Parker, J., McVaney, C., Iennaco, J. D., Bernstein, S. L., & Pavlo, A. J. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.19381 · Cited by 126
Schnitzer, K., Merideth, F. L., Macias‐Konstantopoulos, W., Hayden, D., Shtasel, D. L., & Bird, S. (2020) · Academic Emergency Medicine · doi:10.1111/acem.14092 · Cited by 108
Metadata
- 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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