Treatment in the Least Restrictive Environment

The principle of treatment in the least restrictive setting is a core tenet of behavioral health care. In forensic treatment (i.e., treatment ordered by a criminal court), the “least restrictive” approach means providing care in a setting that preserves an individual’s liberty, autonomy, and dignity to the greatest extent possible, while still ensuring safety, effective treatment, and compliance with legal requirements.

The primary factors for determining placement are whether an individual poses a risk of harm to themselves or others and the level of support and monitoring needed to maintain stability. Generally, treatment should occur on an outpatient basis unless the court determines that treatment on an outpatient basis is reasonably expected to result in serious physical harm upon the individual or another person.

In practice, levels of care exist on a continuum with more restrictive settings providing greater structure, supervision, and security. The most restrictive setting is a secure inpatient psychiatric hospital where individuals may be treated in a locked environment when necessary to ensure safety. Other treatment and residential settings are designed to provide varying levels of support and monitoring while allowing individuals to remain in the community to the greatest extent possible.