Factors affecting the practice of seclusion in an acute mental health service in Southland, New Zealand

Tyrer, Stephen; Beckley, Jay; Goel, Digvijay; Dennis, B. R.; Martin, Benjamin D.

doi:10.1192/pb.bp.111.035790

Cited by 9 publications

(23 citation statements)

References 19 publications

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“…Most seclusion episodes involve threats of assault (Tyrer et al . ) and frequently occur within 2 days of admission (Barlow et al . ) as was found in this study.…”

Section: Discussionmentioning

confidence: 99%

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Jury¹,

Lai²,

Tuason³

et al. 2018

Int J Mental Health Nurs

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The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.

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“…Most seclusion episodes involve threats of assault (Tyrer et al . ) and frequently occur within 2 days of admission (Barlow et al . ) as was found in this study.…”

Section: Discussionmentioning

confidence: 99%

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Jury¹,

Lai²,

Tuason³

et al. 2018

Int J Mental Health Nurs

View full text Add to dashboard Cite

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“…; Tyner et al . ), most were undertaken in specific hospital settings, with wide variations attributed to localized contextual factors, which make comparisons difficult (Janssen et al . ).…”

Section: Introductionmentioning

confidence: 99%

“…Yet little is known about the duration of restrictive interventions in the broader context, or the factors that contribute to the prolonged use. Although studies have focussed on the duration of restrictive interventions (Happell & Gaskin 2011;Janssen et al 2013;Noda et al 2013;Tyner et al 2012), most were undertaken in specific hospital settings, with wide variations attributed to localized contextual factors, which make comparisons difficult (Janssen et al 2011). Studies of the duration of restrictive interventions for entire jurisdictions are scarce (Steinert et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

McKenna

McEvedy

Maguire

et al. 2017

Int J Mental Health Nurs

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Seclusion and mechanical restraint are restrictive interventions that should be used only as a last resort and for the shortest possible time, yet little is known about duration of use in the broader context. Adult area mental health services throughout Victoria, Australia, were asked to complete a report form for prolonged episodes of seclusion (>8 hours) and mechanical restraint (>1 hour). The present, retrospective cohort study aimed to understand the individual (age, sex, type of service, duration of intervention) and contextual factors associated with prolonged use of restrictive interventions. Contextual factors describing the reasons for prolonged use of the restrictive interventions were captured qualitatively, and then coded using content analysis. Median duration was compared across individual factors using Mann-Whitney U-tests. During 2014, 690 episodes of prolonged restrictive intervention involving 311 consumers were reported. Close to half (n = 320, 46%) involved mechanical restraint. Seclusion episodes (n = 370) were longer in forensic mental health services compared to adult area mental health services (median: 24 hours and 18 min vs 16 hours and 42 min, P < 0.001). Mechanical restraint episodes (n = 320) were shorter in forensic mental health services compared to adult area mental health services (median: 3 hours and 25 min vs 4 hours and 15 min, P = 0.008). Some consumers were subject to multiple episodes of prolonged seclusion (55/206, 27%) and/or prolonged mechanical restraint (31/131, 24%). The most commonly occurring contextual factor for prolonged restrictive interventions was 'risk of harm to others'. Means for reducing the use of prolonged restrictive interventions are discussed in light of the findings.

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“…Although directionality cannot be assumed, one interpretation of this study would be that secluding patients potentially lengthens their hospital admission, a proxy measure commonly used to measure illness severity. More recently, a study from New Zealand found that prolonged seclusion times were correlated with poorer treatment (Tyrer 2012). The authors speculate about the cultural reasons for this, suggesting that more 'appropriate treatment' when secluded would minimise seclusion times and admission to hospital.…”

Section: Is Seclusion An Effective Management Tool?mentioning

confidence: 96%

Use of seclusion for managing behavioural disturbance in patients

Newton‐Howes¹

2013

Adv. psychiatr. treat

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SummarySeclusion is a tool used by psychiatrists primarily to manage aggressive and disturbed behaviour that is presumed to be due to the patient's mental disorder. In most parts of the world there are guidelines to using seclusion that are designed to maximise a patient's freedoms and protect their liberty while providing a safe environment. Arguments against the use of seclusion revolve around the deprivation of liberty, the potential for misuse and the concept of seclusion as a form of social control, and patients generally report seclusion as a negative, coercive experience. There is little evidence that seclusion provides long-term benefits in terms of treating symptoms or reducing aggression, although the literature is mixed in this regard. Expert opinion recommends a combination of national policy, ward management and patient-centred interventions to reduce seclusion rates.

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Factors affecting the practice of seclusion in an acute mental health service in Southland, New Zealand

Cited by 9 publications

References 19 publications

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

Use of seclusion for managing behavioural disturbance in patients

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