Seclusion and restraint in 1985: a review and update.

The 1982 Supreme Court decision in Youngberg v. Romeo gave mental health professionals flexibility 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 behavior 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 orientation of the hospital staff, and were more often used to contain behavior that might lead to violence rather than to control violent behavior itself. They conclude 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.