Factors associated with the use of seclusion in an inpatient psychiatric unit in Lilongwe, Malawi

Abstract

BackgroundData on the use of seclusion for psychiatric inpatients in sub-Saharan Africa are extremely limited. Though seclusion is sometimes necessary for patients that pose a threat to themselves or others, adverse physical and psychological sequelae from the experience are increasingly being recognized, leading to efforts to reduce its use. The purpose of this study was to calculate the frequency of seclusion in patients hospitalized in an inpatient psychiatric unit in Lilongwe, Malawi, and to identify factors associated with its use.MethodsRecords of 419 psychiatric inpatients hospitalized at Kamuzu Central Hospital's Bwaila Psychiatric Unit in Lilongwe, Malawi, from January 1, 2011 to December 31, 2011, were reviewed. Multivariate logistic regression analysis was employed to identify factors associated with the use of seclusion.ResultsSeclusion was used for 30.3% (127/419) of patients during the study period. Male patients had increased odds of being secluded (aOR: 2.22, p=0.02). Assaulting other patients on the unit (aOR 7.92, p<0.01) and presenting to the unit in mechanical restraints (aOR 2.33, p<0.01) were also associated with seclusion. There was no association between seclusion and age; diagnosis of alcohol use disorder, marijuana use disorder, or schizophrenia; involuntary admission; presence of extra pyramidal side effects; presence of hallucinations; suicidality; or commission of violent acts prior to admission.ConclusionsDocumentation about the rationale for the use of seclusion on the unit was minimal. Improved record keeping requirements will be essential to future efforts to study seclusion and reduce its use. Development of strategies to address patient violence on the unit could decrease the use of seclusion for aggressive patients. Patients arriving to the unit in restraints would benefit from increased efforts by staff to apply behavioural interventions or administer medications, in order to deescalate these individuals and limit the use of seclusion in their treatment.

Prevalence and variability of restrictive care practice use (physical restraint, seclusion and chemical restraint) in adult mental health inpatient settings: A systematic review and meta‐analysis

“…Individual and institutional variations in the preferences of the methods used to measure, document and/or report restrictive care practice incidents across different geographical regions (Pérez‐Revuelta et al., 2021) or healthcare services could also explain some of these variations (El‐Abidi et al., 2021). This illustrates a need to understand the changing nature of mental health services and adapt similar documentation (Barnett, 2018) and reporting cultures to enhance ongoing monitoring and evaluation of restrictive care practice reduction strategies (McKeown et al., 2020).…”

Seclusion, Restraint, Therapeutic Alliance, and Legal Admission Status: What Really Matters?

“…The likelihood of seclusion was also found to decrease with time since admission in that study, which was not noted in our study. A retrospective study of psychiatric inpatients in Malawi found that male patients had increased odds of being secluded 36. In that study, no association was found between seclusion and age; diagnosis of alcohol use disorder, marijuana use disorder or schizophrenia; involuntary admission; presence of hallucinations; suicidality; or commission of violent acts before admission.…”

Emergency Department Restraint Safety

“…These providers have training in acute management and mitigation techniques that are targeted to address agitation secondary to psychiatric disturbances. A variety of techniques, agitation scoring systems, and clinical triaging tools are present and discussed in the psychiatric literature which allows providers to assess developing and established situations [4,18,19,21,[28][29][30]. These providers can provide additional support and techniques to properly engage with Contemporary Topics in Patient Safety -Volume 2 the patient, better assess the source of their agitation, and provide recommendations on further therapy or medication.…”