Incidents of seclusion and restraint should be kept as low as possible, and it is possible to reduce rates. In a large state-run psychiatric hospital in the United States, for example, rates of seclusion and restraint were reduced through staff training and changes to the treatment culture in the hospital, including changes to unit rules and language, changes to the physical characteristics of the therapeutic environment, and involvement of patients in treatment planning (Borckardt et al., Promoting a patient-centred care environment in hospital settings, and raising the need for awareness of patient safety concerns, can also have a positive impact (Wale et al., This variation suggests significant room for improvement in some prefectures and hospitals. Even more worryingly, the national average rates for seclusion and restraint have risen from 2.4% and 1.6% respectively in 2004 (National Center of Neurology and Psychiatry, 2004), to 3.2% and 3.2% in 2012 (National Center of Neurology and Psychiatry, 2012). Incidents of patient injury, self-harm, or inpatient suicide could be reported by prefecture and nationally, as seclusion and restraint, and involuntary admission are.