Although physical restraint is sometimes essential in psychiatric emergencies, its use in Japan is reported to be excessive.
 In our institution, Yamanashi Prefectural Kita Hospital, only a few patients require restraint each year. This is not because we have tried to reduce restraint but because we have not used restraint historically.
 The advantages of rarely using physical restraint are a reduced burden on patients and enhanced quality of medical care. The disadvantages are that an extended time is required for alternatives to physical restraint, and medical staff interactions with a patient exhibiting difficult behavior can cause problems for other patients. Also, accidents can occur that would have been otherwise prevented by physical restraint.
 There are several reasons for the use of excessive physical restraint in Japan. One may be related to instinctual characteristics typical of Japanese people, such as anxiety sensitivity and uncertainty avoidance. These characteristics might lead to excessive use of physical restraint to ensure patient safety. However, we must view physical restraint as a last resort.
 Involuntary treatment, including physical restraint, should be implemented appropriately, so we should consider whether such treatment is being carried out in line with the patient's best interests and their values. Although it is difficult to judge the values of patients who lose competency to consent, we should establish the most appropriate procedure possible for determining the suitability of involuntary treatment. In our hospital, when judging whether involuntary treatment is appropriate, we assess competency and consider patients' best interests before initiating it.
 In the future, across Japan we must expand the implementation of ethically appropriate procedures for involuntary treatment, including physical restraint.
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