Is the Least Restrictive Environment Always the Best? Sociological and Semantic Implications

Considerable semantic confusion surrounds the use of the concept "least restrictive environment." Imprecise use of this and other terms in planning services for chronic mental patients has been associated with errors in logic and faulty generalizations. Recent events related to out-of-hospital placement of chronic mental patients in a number of communities provide evidence of the potential dangers inherent in using these concepts imprecisely. It is unwarranted to assume that the degree of restrictiveness is determined primarily by the locus of care or to think of "least restrictive environments" as falling along a continuum. A more complex conceptual approach is needed, one that takes into account some of the numerous environmental, patient, and staff variables associated with restrictiveness.