Seclusion and Restraint in Emergency Settings: A Narrative Review

In psychiatry, restraints are considered last resort interventions to manage agitation and aggression. They are sometimes necessary, however, to ensure patient and staff safety. There are several types of restraints, including seclusion and various forms of physical and chemical restraints. While national guidelines emphasize using the least restrictive intervention, there is little empirical data to support the relative restrictiveness and safety of different restraint modalities. In this narrative perspective, we examine the rates, risks, and perceived relative benefits of these interventions in emergency settings, including emergency departments and psychiatric emergency services. Findings reveal a large variation in rates and types of restraint use. Additionally, there is a lack of high-quality research, with wide variability in definitions, study designs, and outcomes measures. This gap hinders development of evidence-based clinical guidelines and contributes to substantial variation in practice across different institutions and settings. The absence of rigorous data may allow institutional culture and individual bias to shape clinical decision-making surrounding one of the most restrictive interventions in psychiatry. Further research using consistent definitions and robust methodologies is essential to inform safer, more effective, and patient-centered practices.