Seclusion and Restraint in 1985: A Review and Update
Paul H. Soloff M.D.1,
Thomas G. Gutheil M.D.2, and
David B. Wexler J.D.3
1 The Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213
2 The Massachusetts Mental Health Center at Harvard Medical School
3 The University of Anzona School of Law
The 1982 Supreme Court decision in Youngberg v. Romeo gave mental health professionals fiexibility to exercise professional judgment in using seclusion to control violent patients, and also suggested that seclusion and restraint might be used when patients exhibit disruptive bebavior ior that may lead to violence. The authors reviewed 13 studies of seclusion and restraint in adult inpatient psychiatric settings to define indications for use. They found that seclusion and restraint practices varied widely depending on the population served and the philosophical onentation of the hospital staff, and were more often used to contain behavior that might lead to violence rather than to control vialent behavior itself. They conduce that there is overwhelming empirical support for using seclusion and restraint to limit the progression of disruptive behavior to actual violence, but that the decision to do so should be based on sound clinical judgment.
