Seclusion, restraint, and involuntary medication

Abstract The use of restrictive and involuntary interventions in correctional settings is sometimes necessary, though it remains fraught with legal and ethical concerns. In recent years, there has been a concerted effort to reduce the use of seclusion and restraint in jails and prisons, given the dangers associated with the practice and the concern about their use for punitive purposes. While some may perceive seclusion and restraint as an intervention ultimately to be eliminated, facilities that use seclusion and restraint for patients with mental illness, be they hospitals, jails, or prisons, should not aim to eliminate it altogether, for in limited cases it is an appropriate option, particularly for acutely aggressive, agitated patients who require immediate intervention. Similarly, the use of psychiatric medication on an involuntary basis, whether on an emergent or nonemergent basis, remains an option for the management of individuals with serious mental illness within the correctional setting to maintain the safety of the individual, other incarcerated persons, and staff. Involuntary medication is also increasingly being used for the purpose of restoring a pretrial detainee to trial competence. This chapter discusses current guidelines on the use of seclusion, restraint, and involuntary medication in correctional health care, as well as the legal precedents that guide their use.