What is already known on this topic?

Seclusion and restraint (SR) are centuries-old, frequently used psychiatric practices which lack an evidence base establishing their therapeutic efficacy.1 They are emergency containment procedures in which staff use physical force, the environment and/or devices to control patient behaviour. Their use creates substantial risk of physical and emotional harm, increases violence, claims significant time and resources and prolongs treatment and recovery from mental illness. For these reasons, reducing and preventing SR use is a growing focus in psychiatric services.2

What does this paper add?

• This paper is evidence that it is possible to use randomised controlled trial methodology to study SR reduction with a volatile, high-risk population in a high-security setting.

• It also demonstrates that an evidence-based practice developed in the USA for non-forensic settings can be successfully implemented in other countries with different languages/cultures and populations without increasing violence.

• This research indicates that SR reduction also reduces SR duration and staff sick leave too.

Limitations

• There are limitations to this work. The …