A straitjacket is a garment designed to restrain a person’s arms and upper body, historically used in psychiatric hospitals to prevent patients from harming themselves or others during severe behavioral crises. While they were once a standard tool in mental health care, straitjackets have largely disappeared from modern hospitals and are now considered outdated and inhumane by mainstream psychiatry.
How a Straitjacket Works
A straitjacket is typically made from heavy canvas or duck cloth, chosen for durability and resistance to tearing. It looks like an oversized jacket with extra-long sleeves that are sewn shut at the ends, which alone prevents any use of the hands. Once someone’s arms are placed in the sleeves, the person applying the restraint crosses the sleeves across the wearer’s chest and ties or buckles the sleeve ends behind the back. This pins both arms tightly against the torso with minimal room for movement.
Several design features make the jacket difficult to escape. Friction buckles fasten the straps, which are nearly impossible to open without a free pair of hands. A crotch strap runs between the legs to stop the wearer from pulling the jacket up and over their head. Some versions include loops at the sides or front where the sleeves are threaded through, preventing the arms from being raised overhead. The overall effect is near-total immobilization of the upper body.
Why They Were Used in Psychiatry
Straitjackets were intended for emergency situations where a patient posed an immediate physical danger, either to themselves through self-harm or to staff and other patients through violent behavior. In theory, they were a last resort after verbal calming techniques failed. In practice, they were frequently used too hastily to prevent anticipated aggression rather than actual aggression, as a form of punishment or behavioral control, or simply because staff found them convenient.
This gap between intended and actual use became one of the central criticisms of straitjackets and physical restraints more broadly. The restraint itself could become a tool of coercion rather than safety, applied based on a staff member’s judgment call rather than a genuine emergency.
Health Risks of Physical Restraint
Restraining a person’s body for extended periods carries real medical consequences. Research on physical restraint complications has documented skin injuries including bruising, swelling, and pressure sores at contact points. Restrained patients face higher rates of delirium, blood clots, and aspiration pneumonia. Repeated or prolonged restraint has been linked to neurofunctional decline, meaning measurable loss of neurological function by the time of hospital discharge. One study found restrained patients had roughly 3.5 times higher odds of neurological impairment at discharge compared to unrestrained patients.
The psychological toll is significant as well. Post-traumatic stress disorder occurs at elevated rates among people who have been physically restrained. Being strapped into a garment that eliminates all upper body movement is, by its nature, a frightening and dehumanizing experience, and mental health organizations now recognize that this psychological harm can actively work against a patient’s recovery.
Current Use: Rare but Not Gone
Modern psychiatric hospitals have effectively abandoned the straitjacket. Dr. Steven K. Hoge, a professor at Columbia University Medical School and former chairman of the American Psychiatric Association’s Council on Psychiatry and the Law, reported that in nearly 35 years of practice, including at the maximum-security mental health unit at Bellevue Hospital in New York City, he never saw or heard of a straitjacket being used on a patient.
They haven’t vanished entirely, though. One U.S. manufacturer, Humane Restraint, sells fewer than 100 units per year. The buyers are overwhelmingly “custodial folks,” meaning jails and prisons. Isolated cases have surfaced involving an Ohio man with Alzheimer’s disease, an 8-year-old with autism in Tennessee, and a prisoner in a Kentucky county jail. These incidents generally reflect settings with poor mental health staffing and resources rather than any accepted medical practice.
The correctional system itself officially discourages their use. Federal prison regulations list straitjackets among the mechanical devices not permitted for punishment, alongside leg irons and spit masks. When restraints are authorized in federal facilities, guidelines require they be the least restrictive option available, used only as a last alternative after all other reasonable efforts to resolve a situation have failed, and only for as long as the immediate threat lasts.
Legal Limits on Any Physical Restraint
Federal regulations impose strict limits on all forms of physical restraint in psychiatric facilities. A restraint order cannot be written as a standing order or on an as-needed basis. Each order must come from a physician or licensed practitioner trained in emergency safety interventions, and it must specify the least restrictive option likely to be effective.
Time limits vary by age. For adults (18 to 21 in residential psychiatric facilities), a single restraint order cannot exceed four hours. For patients ages 9 to 17, the limit drops to two hours. For children under 9, it’s one hour. Within one hour of applying any restraint, a trained practitioner must conduct a face-to-face assessment of the person’s physical and psychological condition. Trained clinical staff must remain physically present and continuously monitor the restrained person for the entire duration. Once the restraint is removed, a practitioner must immediately evaluate the person’s well-being.
What Replaced the Straitjacket
Modern psychiatric care relies on a range of alternatives that prioritize keeping the person engaged rather than immobilized. The most commonly used approach is one-to-one verbal de-escalation, where a staff member talks directly with the patient to reduce agitation. If someone can still carry on a conversation, guidelines call for verbal intervention first.
Beyond conversation, several strategies have proven effective at reducing the need for any physical restraint. Consistent nursing presence on the ward and regular check-ins with patients decrease aggressive incidents by keeping people from reaching crisis points. Collaborative treatment agreements, where doctors, nurses, and patients discuss medications, ward expectations, and triggers together, give patients a sense of participation that reduces confrontation. Sometimes the simple presence of an authority figure, like a senior nurse or physician, is enough to de-escalate a tense situation without any physical intervention.
When physical safety measures are still necessary, hospitals now use soft limb restraints that secure individual wrists or ankles rather than the entire torso. Some patients respond to decreased stimulation in a quiet room with an unlocked door, giving them space to regain control on their own. Medication may also be administered in acute situations, though professional guidelines distinguish this from a patient’s ongoing treatment plan.
A six-component approach tested in Finnish psychiatric wards combined improved leadership, staff training in de-escalation, data tracking of restraint episodes, patient involvement in care decisions, standardized assessment tools for identifying early signs of distress, and post-incident analysis. The result was a measurable reduction in both restraint and seclusion, with no increase in violence on the wards. Major nursing organizations, including the American Psychiatric Nurses Association, now advocate for the sustained reduction and eventual elimination of all restraint and seclusion in psychiatric care.