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Seclusion may be necessary for those clients that are a danger to others.
Restraints might be best for dangerous clients but mostly to self.
We currently use restraint chair and seclusion for child and adult above 9 yo. 
The chair is much more trauma safe and  best for those that are self harming.

​I’m from Australia where I live and work (I do have an American wife so I’m not all bad). I currently work in a medium secure psychiatric unit but we also have within in facility two acute psychiatric units and two intensive care psychiatric units. I have worked across all of them.

WOW. We use verbal de-escalation techniques, we may also use sensory techniques, then we will medicate; followed by seclusion. Her in Australia or at least in my facility we are trying to move away from the use of seclusion. We can use mechanical restraints only if a psychiatrist authorises it. I have never seen a mechanical restraint used in fact I don’t think our facility even has them. Personally I think seclusion has it’s place and if used in the proper manner is very effective and therapeutic.

We are a 65 bed psych hospital as part of a large hospital system in Montgomery, AL.  We have two seclusion rooms that were specifically designed for psych patients.  It is the only place we can restrain our patients as well.  If someone doesn't respond to de-escalation techniques, we call a code R and the decision tree sort of falls out depending upon the patient's response to interventions.  In our facility, we try to do manual hold first with crisis meds.  Then seclusion.  If all else fails, restraint.  We rarely have anyone in restraint longer than an hour as their meds take effect at that point.  hope this helps!

We also only use restraints at the facility that I work. I have always wondered about why we never used seclusion because it seems more humane and less intrusive to me. Sometime restraints are necessary to maintain safety even though many interventions have been put in place to try and prevent there use (March & Caple, 2016) . We have recently implemented music and rooms with less stimulation which has helped bring down our restraint numbers and decrease codes. Sometimes though we get a certain population that really utilize restraints causing out numbers for the month to sky rocket. I have heard of facilities going restraint free but I wonder how they do that. Does anyone have anymore information on restrain free facilities?

March, P., & Caple, C. (2016). Restraint and Seclusion: Minimizing Use in Psychiatric Facilities. CINAHL Nursing Guide,

Seclusion has been very effective in our acute setting, particularly for people with a history of physical abuse/trauma, in that it provides a safe place to vent.

This topic is very interesting.  At our facility the new nurse manager is looking at moving away from seclusion as the first option and using restraints in its place.  Not sure that I agree with this approach because I still believe that the least restrictive measure should be tried if at all possible, and I've seen the quiet/seclusion work effectively for many patients.  I look forward to reading more perspectives regarding this topic.

IF done properly, seclusion can be a brief non-invasive and safer intervention. There is a lot more that can go wrong when using mechanical restraints and more likelihood of re-enacting traumatizing experiences the patient may have had in the past. But a person in seclusion should feel the safety of caring, 'nearby' people, not a sense of prolonged isolation that communicates abandonment. Restraints may be necessary with extreme psychosis where the person will be delusional and self-injurious, eg gouging their eyes etc.  Trauma-informed care will help determine for an individual patient, whether restraints and seclusion are helpful (or not).  It is easier to have a restraint-free milieu IF there is at least a quiet room, but preferably a seclusion room, available. But I haven't worked in the inpatient psychiatric setting now for about 6 years.