De‐escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital

Abstract

In Finland, the Mental Health Act determines the legal basis for seclusion and restraint. Restrictive measures are implemented to manage challenging situations and should be used as a last resort in psychiatric inpatient care. In the present study, we examined the reasons for seclusion and restraint, as well as whether any de-escalation techniques were used to help patients calm down. Seclusion and restraint files from a 4-year period (1 June 2009-31 May 2013) were retrospectively investigated and analysed by content analysis. Descriptive statistics were calculated. A total of 144 episodes of seclusion and restraint were included to analyse the reasons for seclusion and restraint, and 113 episodes were analysed to examine unsuccessful de-escalation techniques. The most commonly-used techniques were one-to-one interaction with a patient (n = 74, 65.5% of n = 113) and administration of extra medication (n = 37, 32.7% of n = 113). The reasons for seclusion and restraint were threatening harmful behaviour (n = 51, 35.4% of n = 144), direct harmful behaviour (n = 43, 29.9%), indirect harmful behaviour (n = 42, 29.1%), and other behaviours (n = 8, 5.6%). In general, the same de-escalation techniques were used with most patients. Most episodes of seclusion or restraint were due to threats of violence or direct violence. Individual means of self-regulation and patient guidance on these techniques are needed. Additionally, staff should be educated on a diverse range of de-escalation techniques. Future studies should focus on examining de-escalation techniques for the prevention of seclusion.

Changing practice using recovery‐focused care in acute mental health settings to reduce aggression: A qualitative study

“…These include early intervention and de‐escalation, assisting the person to learn and utilize anger management strategies or other socially acceptable ways, to support themselves to self‐regulate their behaviour and not become aggressive (Kuivalainen et al . ). However, nurses’ confidence and skills to work collaboratively with the consumer to mitigate the risk for aggression are reported to influence the choice of intervention utilized with the consumer (Happell & Koehn ; McCann et al .…”

Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices

“…What is known is that the type of restrictive practice used and the frequency of use vary across countries, organizations, and individuals (Kuivalainen et al . ; Lepping et al . ).…”

“…These variations are influenced by legislation (that governs the use of such practices), organization factors (type of setting, policies, and procedures), physical/environmental factors (ward atmosphere, use of space), staff characteristics (gender ratio, skill mix, training, experience), and patient characteristics (diagnosis, propensity for aggression;) (Kuivalainen et al . ; Price et al . ).…”

Psychiatric nursing managers' attitudes towards containment methods in psychiatric inpatient care

“…Except for net bed, all of the containment methods considered in this work are used in Finland to some extent (Bak & Aggernæs, 2012; Bowers et al, 2004; Kuivalainen et al, 2017). Net bed was, however, included in this study because it was included in the original, validated questionnaire.…”