A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

Objective: This review examines nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients. Method: Electronic searches were conducted to locate post-1960 empirical studies of restraint and seclusion reduction in English. A total of 36 studies were identified, mostly from the USA. Analysis was conducted using a structured data extraction tool. Results: The majority of studies reported reduced levels or mechanical restraint and/or seclusion, but the standard of evidence was poor. There were no randomised trials. Most were retrospective studies of official records before and after the intervention was introduced, with varying follow-up periods. The interventions were diverse, but tended to include one or more of the following: new restraint and/or seclusion policies, staffing changes, staff training, review procedures and crisis management initiatives. The research was unable to address which of these elements was most effective. There was also evidence that some improved outcomes were achieved by substituting restraint or seclusion for each other or for alternatives forms of containment (medication in particular). Nurses’ attitudes, skills and approach to patient care were absent from the literature. Conclusions: Interventions probably can reduce the use of restraint and seclusion, but better designed research is required to demonstrate their effectiveness conclusively. More attention should also be paid to understanding how interventions work, particularly from the perspective of nursing staff. This is essential to the successful implementation of restraint and seclusion interventions across different psychiatric settings and treatment populations

Gender differences in coerced patients with schizophrenia

European Commission (Quality of life and Management of Living Resources Programme, contract number QLG4-CT- 2002-01036), Czech Ministry of Education research grant MSM002160849, and research grants PRVOUK–P26/LF1/4 and PRVOUK–P03/LF1/

The use of coercive measures in forensic psychiatric care: legal, ethical and practical challenges

The use of coercive measures, namely restraint, seclusion and involuntary medication, remain controversial methods of practice within forensic psychiatry. Ethical and moral debates surrounding the use of coercive measures are compounded by the need to balance care, safety, and security. Despite such tensions, limited research has been conducted in this area. This paper examines the prevalence of coercive measures and factors associated with their use specifically within forensic psychiatry. A systematic review was conducted and fifteen empirical studies were identified, each examining the use of coercive measures in forensic inpatient psychiatry, reported in papers published between January 1980 and January 2012. Findings suggest that patients who are younger or newly admitted tend to be secluded most often. Findings relating to gender, ethnicity and patient diagnoses, however, are equivocal. Patients tend to perceive experiences of coercive measures negatively. Staff perceptions however, appear to be determined by their role in governing or practicing coercive interventions. Findings are discussed in light of variations in hospital settings, policies and sociocultural traditions. While the uses of coercive measures appear to be influenced by a combination of all patient, staff, and environmental factors, further research is required to explore each of these aspects in greater detail

Incidence of seclusion and restraint in psychiatric hospitals: A literature review and survey of international trends. Social Psychiatry Psychiatric Epidemiology,

Abstract Objective The aim of this study was to identify quantitative data on the use of seclusion and restraint in different countries and on initiatives to reduce these interventions. Methods Combined literature review on initiatives to reduce seclusion and restraint, and epidemiological data on the frequency and means of use in the 21st century in different countries. Unpublished study was detected by contacting authors of conference presentations. Minimum requirements for the inclusion of data were reporting the incidence of coercive measures in complete hospital populations for defined periods and related to defined catchment areas. Results There are initiatives to gather data and to develop new clinical practice in several countries. However, data on the use of seclusion and restraint are scarcely available so far. Data fulfilling the inclusion criteria could be detected from 12 different countries, covering single or multiple hospitals in most counties and complete national figures for two countries (Norway, Finland). Both mechanical restraint and seclusion are forbidden in some countries for ethical reasons. Available data suggest that there are huge differences in the percentage of patients subject to and the duration of coercive interventions between countries. Conclusions Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice

The effects of a nationwide program to reduce seclusion in the Netherlands

Contains fulltext : 102989.pdf (publisher's version ) (Open Access)Background: From 2006 to 2009, the Dutch government provided (sic)5 m annually for a nationwide program to reduce seclusion in psychiatric hospitals by 10% a year. We aimed to establish whether the numbers of both seclusion and involuntary medication changed significantly after the start of this national program. Methods: Using Poisson regression to estimate difference in logit slopes, we analyzed data for 1998-2009 from the Dutch Health Care Inspectorate, retrospectively examining the national numbers of seclusion and involuntary medication before and after the start of the program. Results: The difference in slopes of the numbers of seclusion before and after the start of the program was statistically significant (difference 5.2%: p < 0.001). After the start of the program seclusions dropped 2.0% per year. Corrected for the increasing number of involuntary hospitalizations this figure was 4.7% per year. The difference in slopes of the numbers of involuntary medication did not change statistically significant (difference 0.5%, n.s.). After correction for the increasing number of involuntary hospitalizations the difference turned significant (difference 3.3%, p = 0.002). Conclusions: After the start of the nationwide program the number of seclusions fell, and although significantly changing, the reduction was modest and failed to meet the objective of a 10% annual decrease. The number of involuntary medications did not change; instead, after correction for the number of involuntary hospitalizations, it increased.4 p