The use of seclusion and physical restraint is viewed as a practice incompatible with the vision of recovery, and its therapeutic benefit remains unsubstantiated. This Open Forum describes an initiative that began in 1999 at two crisis centers that was designed to completely eliminate the practice of seclusion and restraint. Seclusion and restraint elimination strategies included strong leadership direction, policy and procedural change, staff training, consumer debriefing, and regular feedback on progress. Existing records indicated that over a 58-month follow-up period (January 2000 to October 2004), the larger crisis center took ten months until a month registered zero seclusions and 31 months until a month recorded zero restraints. The smaller crisis center achieved these same goals in two months and 15 months, respectively. The success of this initiative suggests that policy makers and organizational leaders familiarize themselves with these and other similar seclusion and restraint reduction strategies that now exist.

Findings suggest that a standardized program designed to provide peer training was used successfully and participants' recovery and employability were improved. Further studies are recommended to rigorously test peer providers' impact on their clients and to examine the advantages that accrue to the agency when mental health recipients are employed as peer providers.

The mental health field continues to be concerned about the use of seclusion and of mechanical and chemical restraints in treatment settings. Recovery Innovations, Inc. (RI), a nonprofit corporation that operates a range of recovery-oriented programs, successfully eliminated use of seclusion and nonchemical restraints in a crisis center. This success was the impetus behind implementation and evaluation of a "no force first" (NFF) policy, described in this column, that targeted the crisis center's use of chemical restraint. Successful implementation of the policy in the crisis center led to the concurrent adoption of the NFF policy as a best practice at all of RI's 19 behavioral health programs.