Incidence of Using Physical, Mechanical Restraints and Seclusion in Saudi Mental Health Settings: A Prospective Cohort Study

Background/Objectives: The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have been expectations that such interventions would no longer be required; however, their use persists in clinical practice. Management policies differ across countries and are largely influenced by legal frameworks. This study aimed to identify the factors influencing the incidence of these interventions across two psychiatric facilities in Saudi Arabia and to examine associations among inpatient variables. Methods: A prospective cohort study was conducted over six months (September 2021–March 2022) across two psychiatric facilities in Saudi Arabia (Eradah Complex, n = 1120; King Fahd University Hospital (KFUH), n = 268). Data from 333 restriction events were analysed using descriptive statistics, chi-square tests, and negative binomial regression to calculate incidence rates and explore associated factors. Results: The findings revealed a complex interplay of factors related to patient characteristics and clinical and environmental conditions within the facilities. Key contributing variables included symptom deterioration and the duration of observation required. Longer observation periods were associated with certain diagnoses, particularly schizophrenia and mood disorders. Conclusions: Restraints and seclusion remain influenced by multiple interacting factors within psychiatric settings. These findings highlight the need to reduce their use and ensure they are applied cautiously, with greater emphasis on minimising patient trauma and promoting safer, person-centred care.