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  • Oral presentation
  • Open Access

The need to develop alternative measures to seclusion and restraint

  • 1
BMC Psychiatry20077 (Suppl 1) :S63

  • Published:


  • Public Health
  • Prevention Program
  • Economical Cost
  • Alternative Measure
  • Psychiatric Symptom

In studies of psychiatric inpatients, the incidence of seclusion or restraint (S/R) varies widely (0-66%). Frequent use has been associated with e.g. violent behavior, age, sex, psychiatric symptoms and diagnosis of the patient, but also with the ward culture. The use of S/R is problematic since no randomized controlled studies of the safety or effectiveness of them were published. S/R may save lives and prevent injuries in acute violent or suicidal incidences. However, the indications and durations of the coercive methods vary widely between units. Considerable economical costs, and psychological and physical injuries of both patients and nurses associated with S/R have been reported. In USA, S/R has been highly prioritized since 1998 when the publicity of over 140 S/R-related deaths lead to congressional hearings. Patients with psychiatric symptoms are particularly vulnerable for stress, and many of them have suffered from maltreatment. Frequent use of S/R may increase stress on the ward, harm therapeutic relations, the effect of medicines, and the recovery. Several countries, settings and nursing organizations (e.g. APNA) have projects committed to the reduction of S/R. Some promising prevention programs of violent behavior of psychiatric patients have been developed. Randomized controlled trials of S/R, and alternative methods for containment of violent behavior are needed.

Authors’ Affiliations

Kuopio University, Faculty of Forensic Psychiatry, Niuvanniemi Hospital, 70240 Kuopio, Finland


© Putkonen; licensee BioMed Central Ltd. 2007

This article is published under license to BioMed Central Ltd.