Factors influencing decisions of mental health professionals to release service users from seclusion: A qualitative study

Abstract

Aim:This study aims to explore and understand factors influencing the decisions of mental health professionals releasing service users from seclusion.Background: Seclusion should only be used as a last resort and for the minimum possible duration. Current evidence outlines which service users are more likely to be secluded, why and what influences professionals' decision to seclude. Little is known about factors professionals consider when releasing service users.Design: A qualitative study was undertaken to explore factors which influence decision-making of mental health professionals when terminating episodes of seclusion.Methods: Semi-structured face-to-face interviews with 21 professionals were undertaken between May 2017-January 2018. Framework analysis was used to systematically manage, analyse, and identify themes, while maintaining links to primary data and providing a transparent audit trail.Results: Six themes were identified where professionals looked for service users to demonstrate cooperation and compliance before they would be released. Decisions were subjective, being influenced by the experience and composition of the review team, the availability of resources plus the emotional tone and physical environment of the ward. Release could be delayed by policy and protocol. Conclusion: Professionals should have greater awareness of factors that hinder or facilitate decisions to release service from seclusion and an understanding of how service user views and involves in decisions regarding seclusion should be explored. Impact: Senior staff should be available to facilitate release at the earliest opportunity. Staff should ensure that policy and procedures do not prolong the time service users remain secluded. K E Y W O R D S coercion, decision-making, multidisciplinary working, nurse, nursing, restrictive intervention, seclusion | 2179 JACKSON et Al.

Staff perspectives on the effects of seclusion in adolescent psychiatric inpatient care

“…Patients and staff may both experience trauma because of seclusion (Krieger et al 2020) yet there is little known about their perspectives on the effects of seclusion both on them and on patients. Nevertheless, staff support the use of seclusion, in particular for patients who are aggressive or violent because they see no alternative to protect other patients, themselves, and the patient being secluded (Jackson et al 2019;Krieger et al 2020;Power et al 2020). Most data on these staff opinions come from surveys of staff working with adults.…”

“…Nevertheless, staff support the use of seclusion, in particular for patients who are aggressive or violent because they see no alternative to protect other patients, themselves, and the patient being secluded (Jackson et al . 2019; Krieger et al . 2020; Power et al .…”

Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units

“…In terms of staffing factors, there is evidence that staffing levels and confidence within a team affect decision-making in terms of initiating and terminating seclusion. [15][16][17] Staffing levelsparticularly of senior stafftend to be reduced out of hours, and seclusion episodes that are initiated during the weekend tend to be longer, 18 so it is plausible that this would impact the success of seclusion termination. Given that medical staff have been viewed as having a distinctive role in the process of seclusion, 19 and the presence of a senior doctor is associated with the termination of seclusion, 18 we speculated that involving doctors in decision-making may also affect the success of seclusion termination.…”

“…In terms of patient factors, qualitative research has suggested that ward staff place an emphasis on people cooperating with their care when deciding whether to terminate seclusion. 16 One of the more measurable manifestations of this is medication cooperation. Regarding psychopathology, aggression and agitation have been identified as being predictive of seclusion initiation.…”