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Okay, here is my hot take. Get rid of paternalistic involuntary commitment, and you will cut down the instances of violence by half. (Most of the remainder will probably be prisoners in forensic psychiatry, e.g. people who committed (mostly violent) crimes but were found not guilty for reasons of insanity. These are probably best considered prisoners first and patients second, just like normal, sane, sociopath serial killer serving life who also has a bad toothache is unlikely to be rendered less of a danger because of his medical condition.)
Specialties of medicine which respect patient autonomy presumably have a vastly lower incidence of patients turning violent. Take oncology. Breaking off a promising chemotherapy is probably among the treatment decisions which carry the highest QALY cost, outside of outright committing suicide while healthy. Yet for adult patients, society and healthcare professionals generally accept that it is the patients decision. Very few cancer patients will attack a nurse out of desperation, because if they want to leave, they are just one signature of their own death warrant ("leaving against medical advice") away from getting out.
Contrast with specialties which do not give a damn about patient's autonomy, psychiatry first and foremost. I wish I could say that a month in a psych ward had the same long term QALY gain associated with a month undergoing a promising chemotherapy, but while both treatments may share a similar quality of life during treatment (i.e. utter misery), the long term outcomes of these intervention are as different as different as a shot of rum and fentanyl are for pain management: in my experience, the main goal of psychiatry is to keep their patients alive for another day. A mostly functioning patient going into a locked ward for debatable psychotic symptoms might emerge a month later addicted to benzodiazepines (which effectively removes them as a further treatment option), prescribed some antipsychotic (which he will stop taking at the earliest opportunity), having experienced physical restraint (because people who mostly cope with life in freedom sometimes cope badly when put in very stressful situations) and a life-long conviction that anything related to the mental health system is utterly evil and terrible (which further limits their treatment options). (On reflection, likening this to rum for pain management seems optimistic, and it might be closer to chewing glass for pain management.)
(I am fine with people who attempt to kill themselves without success or are expressing the intend to commit suicide spending a few days locked up for their defection around social norms. There is no intrinsic right to fail to kill yourself or distress others with your plans. Just let them out after a few days, and hope that they have overcome their acute suicidality, learned their lesson either about threatening suicide, or the lesson about which way to cut and keeping their mouth shut -- suicide is a human right, after all.)
If a base jumper falls to his death, that is sad, but not particularly upsetting. After all, when he took on his hobby, he was perfectly aware that humans are ill-suited for gliding close to the ground.
If someone who has made it their profession to lock people up without them having violated criminal laws gets attacked by one of his prisoners, that is also sad (and generally wrong and evil on the part of their prisoners, because typically it will not lead to them escaping), but also not particularly upsetting. Treating people as unable to make decisions about their own life (which is why you lock them up, after all), while also expecting them to respect norms of polite society e.g. about not sticking a cake fork into through your eye socket seems to be both hypocritical and utterly foolish.
Further reading of my opinions.
On a broader level if anything it should be increased. Instead of releasing clearly schizo criminals 50 times in a row so they can finally set a lady on fire or kill some one and be put in jail, instead of the 3rd time they punched some one randomly on the street having them committed involuntarily in an asylum.
If you read my quote very carefully, you will notice that the fourth word is "paternalistic".
Putting someone into forensic psychiatry for crimes they committed is not paternalistic, it is clearly 'for the good of society', not 'for their own good'.
I have no problem with putting people into forensic psychiatry, provided that that get their day in criminal court, that their maximum stay duration is no longer than the penalty the law provides for their offense, and that they have the option to transfer to regular prison if they want to.
So if you jurisdiction allows for sentencing a sane person to life in prison for their third unqualified assault (which might set bad incentives on its own, however), I have no objection to you locking up a psychotic offender in forensic instead.
Of course, this also involves society being willing to pay the costs of keeping someone locked up in a psych ward long term, not only for patients who are naturally inclined towards violence, but also towards any patients which might prefer this to being left to their own devices, if they exist (because qualifying on purpose would be trivial).
That assumes they should be locked up after committing a crime, I think I'm proposing something you're completely against. I want the homeless and the violently insane institutionalized before they offend. Being homeless shouldn't be a crime, being homeless again after being supplied housing and a drug rehab program but then choosing nah, lets be homeless again and do drugs should get you involuntarily committed even before you start assaulting people.
Same for the randomly schizophrenic and psychotic roaming the streets without rap-sheets. Hell, you could have something like a cross between half-way houses and sanitoriums for the less pathological cases. Where the staff makes sure you take your meds while re-integrating into society in a structured environment.
Anything but the current status quo of dumping these disordered people on the streets we currently have going on.
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I apologize if I missed something here, it's been a long day at work.
You are making two mistakes I think.
The first thing to note is that the vast majority of restraint encounters are in the ED with mostly undifferentiated agitation. That almost always ends up being drugs or medical illness.
Patients who end up in a psychiatric unit, well the vast majority of restraints are for violence towards others not the self.
If you are a reader here and you've been in a psych unit it's probably been for suicidal ideation and it was probably in a cushy unit. The majority of inpatient psych work involves violent criminals, drug users, and the severely mentally ill (ex: schizophrenia, bipolar) - not depression.
An untreated manic episode prior to modern medical care had a 20-25 percent fatality rate due to getting themselves killed in one way or another.
Even if we gave up on the suicidal it really wouldn't solve the problem.
Protecting other people from the crazy and foul tempered is important.
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