Performance improvement through monitoring seclusion and restraint practices

With the increasing development of legal and clinical standards for seclusion and restraint, measurement of compliance with legal and clinical standards is an important component of mental health performance improvement processes. The authors report on a systematic sample of 229 episodes of seclusion and/or restraint use in 46 facilities reviewed by county patients' rights advocates in seven California counties for compliance with standards. Lack of compliance with requirements regarding seclusion and restraint was substantial in four areas: legality of the orders, employment of less restrictive alternatives, legal grounds for initiating and continuing the orders, and nursing care during restraint or seclusion.