Original Paper

Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 9, pp 889-897

First online:

Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends

  • Tilman SteinertAffiliated withCentres for Psychiatry Suedwuerttemberg, Ulm University Email author 
  • , Peter LeppingAffiliated withUniversity of Wales, Bangor and North Wales NHS Trust, Wrexham Academic Unit
  • , Renate BernhardsgrütterAffiliated withPsychiatrische Klinik Wil, St. Gallische Kantonale Psychiatrische Dienste—Sektor Nord
  • , Andreas ConcaAffiliated withDepartment of Psychiatry I, Regional Hospital of Rankweil
  • , Trond HatlingAffiliated withHealth services research, SINTEF
  • , Wim JanssenAffiliated withGGNet, Network of Psychiatric Hospitals in the Eastern Region of The Netherlands
  • , Alice Keski-ValkamaAffiliated withVanha Vaasa HospitalTampere School of Public Health, University of Tampere
  • , Fermin MayoralAffiliated withHospital Regional Universitario Carlos Haya
  • , Richard WhittingtonAffiliated withSchool of Health Sciences, University of Liverpool

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The aim of this study was to identify quantitative data on the use of seclusion and restraint in different countries and on initiatives to reduce these interventions.


Combined literature review on initiatives to reduce seclusion and restraint, and epidemiological data on the frequency and means of use in the 21st century in different countries. Unpublished study was detected by contacting authors of conference presentations. Minimum requirements for the inclusion of data were reporting the incidence of coercive measures in complete hospital populations for defined periods and related to defined catchment areas.


There are initiatives to gather data and to develop new clinical practice in several countries. However, data on the use of seclusion and restraint are scarcely available so far. Data fulfilling the inclusion criteria could be detected from 12 different countries, covering single or multiple hospitals in most counties and complete national figures for two countries (Norway, Finland). Both mechanical restraint and seclusion are forbidden in some countries for ethical reasons. Available data suggest that there are huge differences in the percentage of patients subject to and the duration of coercive interventions between countries.


Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice.


Seclusion Restraint Epidemiology Mental health care