Reading time: 2 minutes, 15 seconds (559 words)
Seclusion should only be used as a last resort to prevent pending harm. It should never be used for punishment nor staff convenience.
Although seclusion is sometimes clinically needed, the frequency, length, and administration of seclusion — and the trauma it often causes — are not aligned with a patient-centred system of mental health care.
Dr. Gary Chaimowitz and his coauthors provide practical suggestions on how Canada can reduce the use and harm of seclusion, pointing to Ireland as a template for what can be achieved.
This is a plain language summary of:
Chaimowitz, G., Kates, N., & Davoren, M. (2026). Seclusion in Canada: Time for a radical change [Commentary]. Can J Psychiatry. Article 7067437261448740. Advance online publication. https://doi.org/10.1177/07067437261448740
Seclusion in Canada
In seclusion, patients in health care and psychiatric facilities are confined alone in a room they cannot leave. Physical or chemical restraints may also be used.
While provinces and territories in Canada have tried to reduce the use of seclusion, progress has varied across the country. An Ontario mental health facility used evidence-based practices and reported a 90 per cent reduction in restraint and seclusion hours. A forensic psychiatry hospital in British Columbia reported a 27 per cent decrease in seclusion days and a 90 per cent decrease in violent incidents. However, a Quebec mental health hospital saw a 205 per cent increase in seclusion use in one year.
“Seclusion continues to appear in coroners’ reports, lawsuits, and media exposes. Further, class actions in Ontario have alleged patients have endured prolonged, harmful ‘solitary confinement’ under the guise of care,” the authors write.
“These are symptoms of wider system issues: our systems of governance, infrastructure, and clinical oversight are not keeping pace with modern mental health care.”
Systemic Changes Needed
In their commentary, the authors advocate for a “national, patient-centred, accountable approach with consistent standards.”
They point to Ireland as an example of how national leadership can drive change. They implemented national oversight, reporting requirements, standards for rooms, and regular medical reviews. Between 2018 and 2022, seclusion fell 24 per cent and physical restraints fell 48 per cent.
The authors propose six changes that would make seclusion safer, preserve dignity, minimize traumatize, and better reflect current psychiatric principles of patient-centred care.
- Design of seclusion spaces: British Columbia’s Secure Rooms Standards and Guidelines can be used as a detailed template for the rest of Canada.
- Real-time monitoring: In-person and closed-circuit television with central monitoring are needed to reduce harm and ensure timely intervention.
- Clinical oversight and records: Staff should document every use of seclusion in a detailed standardized format and summary data reported annually.
- Staff training: Direct care providers should be trained in trauma-informed care, de-escalation, risk reduction, and early recognition of agitation and distress.
- National standards: Strong national leadership is needed to minimize the wide variability already seen; however, provinces and territories would oversee adherence.
- Legislative reform: Provinces and territories should clearly define and set limits on seclusion in their mental health acts.
“Ireland’s progress shows that robust regulation and redesign can halve restrictive practices in 5 years,” the authors conclude. “Canada can do the same if federal and provincial leaders, accreditation bodies, and clinician-advocates seize this moment. The tools are there. The evidence exists. What we need now is resolve.”
Written by Virginia St-Denis and approved by Dr. Gary Chaimowitz.
