Psychiatric patients have an increased risk for choking compared with the general population because of risk factors such as medication side effects and food gorging. A state hospital program for managing patients with dysphagia, or difficulty swallowing, includes interventions such as modified diets, mealtime monitoring, and adjusting psychotropic medications. Clinicians may find it difficult to make decisions about privileges and placement for dysphagic patients who do not comply with dietary modifications in unsupervised settings. For many such patients, close supervision and even placement on a locked ward may seem necessary. The authors recommend a risk-benefit approach: clinicians must balance the safety afforded by restrictions against the benefits of increased privileges or placement in a less restrictive setting. Quality of life and patients' preferences must also be considered.