Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 9, pp 889–897

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

  • Tilman Steinert
  • Peter Lepping
  • Renate Bernhardsgrütter
  • Andreas Conca
  • Trond Hatling
  • Wim Janssen
  • Alice Keski-Valkama
  • Fermin Mayoral
  • Richard Whittington
Original Paper

DOI: 10.1007/s00127-009-0132-3

Cite this article as:
Steinert, T., Lepping, P., Bernhardsgrütter, R. et al. Soc Psychiat Epidemiol (2010) 45: 889. doi:10.1007/s00127-009-0132-3



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 Unpublished study was detected by contacting authors of conference presentations.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 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Tilman Steinert
    • 1
  • Peter Lepping
    • 2
  • Renate Bernhardsgrütter
    • 3
  • Andreas Conca
    • 4
  • Trond Hatling
    • 5
  • Wim Janssen
    • 6
  • Alice Keski-Valkama
    • 7
    • 8
  • Fermin Mayoral
    • 9
  • Richard Whittington
    • 10
  1. 1.Centres for Psychiatry SuedwuerttembergUlm UniversityRavensburg-WeissenauGermany
  2. 2.University of Wales, Bangor and North Wales NHS Trust, Wrexham Academic UnitCardiffWales, UK
  3. 3.Psychiatrische Klinik WilSt. Gallische Kantonale Psychiatrische Dienste—Sektor NordZurcherstrasseSwitzerland
  4. 4.Department of Psychiatry IRegional Hospital of RankweilRankweilAustria
  5. 5.Health services researchSINTEFTrondheimNorway
  6. 6.GGNet, Network of Psychiatric Hospitals in the Eastern Region of The NetherlandsWarnsveldThe Netherlands
  7. 7.Vanha Vaasa HospitalVaasaFinland
  8. 8.Tampere School of Public HealthUniversity of TampereTampereFinland
  9. 9.Hospital Regional Universitario Carlos HayaMalagaSpain
  10. 10.School of Health SciencesUniversity of LiverpoolLiverpoolUK

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