Regulatory change: a pathway to eliminating seclusion and restraint or "regulatory scotoma"?

Historical and current experience indicates that regulatory changes in seclusion and restraint practice are often spurred by patient abuse but can ultimately enhance protection for consumers, prevent use of seclusion and restraint, and help transform care so it becomes recovery oriented. Reports of deaths related to restraint and seclusion fueled recent national regulatory changes and a federal agenda to eliminate their use. Some states, many facilities, and the federal initiative have focused on seclusion and restraint prevention and alternatives and have made important strides in reducing and eliminating these practices. However, new national regulations lessen previous oversight requirements, heighten risk, and threaten gains in reducing and eliminating such practices. Courageous, knowledgeable leadership is needed to challenge these minimum-practice thresholds and prevent seclusion and restraint "regulatory scotoma."