Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review

Abstract

Increasing efforts are being made to prevent and/or eliminate the use of seclusion and restraint in mental health facilities. Recent literature recognises the importance of the physical environment in supporting better outcomes in mental health services. This rapid review scoped the existing literature studying what physical design features of mental health facilities can reduce the use of seclusion and physical restraint.DesignA rapid review of peer-reviewed literature.MethodsPeer-reviewed literature was searched for studies on architectural design and the use of restraint and seclusion in mental health facilities. The following academic databases were searched: Cochrane Library, Medline, PsycINFO, Scopus and Avery for English language literature published between January 2010 and August 2019. The Joanna Briggs Institute’s critical appraisal tool was used to assess the quality of included studies.ResultsWe identified 35 peer-reviewed studies. The findings revealed several overarching themes in design efforts to reduce the use of seclusion and restraint: a beneficial physical environment (eg, access to gardens or recreational facilities); sensory or comfort rooms; and private, uncrowded and calm spaces. The critical appraisal indicated that the overall quality of studies was low, as such the findings should be interpreted with caution.ConclusionThis study found preliminary evidence that the physical environment has a role in supporting the reduction in the use of seclusion and restraint. This is likely to be achieved through a multilayered approach, founded on good design features and building towards specific design features which may reduce occurrences of seclusion and restraint. Future designs should include consumers in a codesign process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience expertise.

Space and Well-Being in High Security Environments

“…Personalization and freedom of choice, the third parameter, refers to the degree of freedom the client can achieve in a facility ( 37 ). A recent rapid review by Oostermeijer et al ( 38 ) found preliminary evidence that the use of good design and architecture principles can help to prevent measures of seclusion and restraint in psychiatric facilities. The importance of the physical environment in psychiatric settings has also been considered in a safety model of psychiatric care, e.g., the Safewards model ( 39 ).…”

Relational security: The impact of facility design on youth custodial staffs' practices and approaches

“…In the mental health care sector, certain aspects of facility design have been associated with aggressive behaviours, stress levels, use of restraint and seclusion, length of stay, mental health outcomes and resident and staff wellbeing (Connellan et al., 2013; Oostermeijer et al., 2021; Ulrich et al., 2018). The notion of therapeutic design refers to design that is conducive to the mental health, wellbeing and rehabilitation of its residents.…”

The Reorganization of a Psychiatric Unit During COVID-19: A Reflection for Psychiatric Hospital Design

“…Described as “spaces of transition,” the psychiatric environment provides stability, space for social interaction, and skill development for patients to successfully transition back to the community ( Chrysikou, 2019 ; Wood et al, 2013 ). The design of psychiatric environments is transforming from a stale institutional environment to healing into therapeutic environments, focusing on design features that result in less aggression and a reduction of the use of coercion (e.g., seclusion or restraint) on the wards ( Oostermeijer et al, 2021 ; Papoulias et al, 2014 ; Seppänen et al, 2018 ; Shepley & Pasha, 2017 ; Shepley et al, 2016 ; Ulrich et al, 2018 ). Based on Ulrich’s work, there has been a recent movement to design psychiatric environments based on healing architecture ( Lundin, 2021 ).…”