Commentary: seclusion practice in a Canadian forensic hospital.

The article, "Seclusion Practice in a Canadian Foren sic Hospital," by A. G. Ahmed and M. Lepnurm1 evokes further questions about the use of seclusion and restraint in psychiatric hospitals. This subject remains at the heart of intense debatewithin psychi atric and consumergroups, and recently there have been legislative interventions that have intensified the discussion. Although most of the debate and re search have focused on the civil psychiatric hospital, there is comparatively little information available about the practiceofseclusion and restraint in foren sichospitals or in those facilities that provide psychi atric care to prison inmates, as in this example. Guttheil and Applebaum2 provide a brief review ofsome of thebenefits ofseclusion, which they com pare witha prescription ofspace, that may behelpful in providing external controls to disturbed patients who have poor internal controls. They note a num ber of potential advantages, including containment for the out-of-control patient, isolation from dis tressing interpersonal relationships, and diminished sensory input. They caution, however, that seclusion and/or restraint can beeasily misused, in particular if it serves a punitive function, is a substitute for staff time or attention, or is a mechanism for the acting