Least Restrictive Care

Least restrictive refers to patients' civil rights and their right to choice of care. There are four specific themes of historical and clinical importance:

1.

Patients should be treated in those settings that least interfere with their civil rights and freedom to participate in society.

2.

Patients should be able to disagree with clinician recommendations for care. While this includes the right to refuse any care at all, it also includes the right to obtain care in a setting of their choice (as long as considerations of dangerousness and mental competency are satisfied). It implies a patient's right to seek a higher or different level of care than that which the clinician has planned.

3.

Patients should be informed participants in defining their care plan. Such planning should be done in collaboration with their healthcare providers.

4.

Careful consideration of State laws and agency policies is required for patients who are unable to act in their own self-interests. Because the legal complexities of this issue will vary from State to State the TIP cannot provide definitive guidance here, but providers need to consider whether or not the person is “gravely” incapacitated, suicidal, or homicidal; likely to commit grave bodily injury; or, in some States, likely to cause injury to property. In such cases, State law and/or case law may hold providers responsible if they do not commit the patient to care, but in other cases programs may be open to lawsuits for forcibly holding a patient.