Restraints and seclusion in psychiatry: striking a balance between protection and coercion. Critical overview of international regulations and rulings

Riv Psichiatr. 2020 Jan-Feb;55(1):16-23. doi: 10.1708/3301.32714.


Restraint and seclusion (R&S) measures in psychiatric settings are applied worldwide, despite poor scientific evidence to back up their effectiveness. The medical, ethical and medico-legal implications of coercive interventions are broad-ranging and multifaceted. The review aims to shed a light on the most relevant and meaningful standards that have been laid out by international treaties, supranational institutions (United Nations, Council of Europe, World Health Organization), scientific institutions (American Medical Association, Australian Department of Health), legislative bodies and courts of law. Several court cases are herein expounded upon, with a close focus on meaningful analysis, decisions and conclusions that have laid the groundwork for a different, more restrictive and more clearly defined approach towards R&S imposed upon psychiatric patients. It is reasonable to assume that changing norms, civil rights enforcement, court rulings and new therapeutic options have influenced the use of R&S to such an extent that such measures are among the most strictly regulated in psychiatric practice; health care providers should abide by a strict set of cautionary rules when making the decision to resort to R&S, which must never be put in place as a substitute for patient-centered therapeutic planning. Case law shows that R&S should only be weighed in terms of their effectiveness towards therapeutic goals. Being able to prove that R&S was employed as part of a therapeutic path rather than used to maintain order or to exact punishment may go a long way towards shielding operators against negligence lawsuits and litigation.

Publication types

  • Review

MeSH terms

  • Coercion*
  • Commitment of Mentally Ill / ethics
  • Commitment of Mentally Ill / legislation & jurisprudence
  • Commitment of Mentally Ill / standards
  • Denmark
  • Germany
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Institutionalization / ethics
  • Institutionalization / legislation & jurisprudence
  • Institutionalization / standards*
  • International Agencies / standards
  • Internationality* / legislation & jurisprudence
  • Italy
  • Liability, Legal
  • Mental Disorders*
  • Practice Guidelines as Topic
  • Psychiatry / legislation & jurisprudence
  • Restraint, Physical / ethics
  • Restraint, Physical / legislation & jurisprudence
  • Restraint, Physical / standards*
  • Societies, Medical
  • United States