Impact of the physical environment of psychiatric wards on the use of seclusion

Schaaf, P. S. van der; Dusseldorp, Elise; Keuning, F. M.; Janssen, W; Noorthoorn, Eric

doi:10.1192/bjp.bp.112.118422

Cited by 105 publications

(95 citation statements)

References 32 publications

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“…In the same time, the sample increased from a selected population of eight hospitals in 2008, over a representative sample in 2010, to a near to nation-wide coverage in 2012 (Table 3). While the first 14 hospitals in 2008 and 2009 covered about 14,900 patients and 23,000 admissions (28), the findings gathered in 2012 covered 130,000 admissions and over 59,000 patients.…”

Section: Seclusionmentioning

confidence: 99%

“…More recently, in line with the English Psychiatric Intensive Care Units (PICU’s) a number of hospitals are developing intensive care as a specialization of Mental health care. Development of intensive care units not only aims at new building environments (28), but also at an increased professionalization of the care provided (52). In 19 psychiatric hospitals, a system of quality audits was set up to investigate the care provided.…”

Section: Clinical Guidelinesmentioning

confidence: 99%

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The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

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In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million € was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.

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Section: Seclusionmentioning

confidence: 99%

Section: Clinical Guidelinesmentioning

confidence: 99%

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

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“…Similar differences have been reported between different treatment wards [6]. This can be only partly explained by patient compilation [7] and the physical environment of the psychiatric wards [8]. Nurses have reported that the decision-making process for managing patients’ aggressive behavior poses inherent ethical dilemmas [9].…”

Section: Introductionmentioning

confidence: 66%

Psychiatric staff on the wards does not share attitudes on aggression

Laiho

Lindberg

Joffe

et al. 2014

Int J Ment Health Syst

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BackgroundThe concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions.MethodsThe Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent’s gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables.ResultsMost of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance.ConclusionsPsychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.

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“…Visibility is a factor that has also been significantly associated with reduction in aggression and reduction in levels of seclusion on inpatient wards (Van der Schaaf, 2013). Changes in the EAI demonstrate that this increased with the new ward.…”

Section: Discussionmentioning

confidence: 97%

“…One study demonstrated that following a 50% reduction in bed numbers, although severe aggressive incidents to staff decreased, inter-patient violence actually increased (Palmstierna & Wistedt, 1995). Recently, a large multi-centred study, using seclusion as an outcome measure, showed that having more private space per patient, greater comfort and better visibility on the ward all contributed to a reduction in the need for restrictive measures on acute psychiatric units (Van der Schaaf et al 2013).…”

Section: Introductionmentioning

confidence: 98%

A study of agitation, conflict and containment in association with change in ward physical environment

Jenkins

Dye

Foy

2014

J. Psychiatr. Intensive Care

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Aims: To assess the impact of a changed ward environment upon levels of inpatient arousal and aggression on a National Health Service psychiatric intensive care unit.Method: A retrospective service evaluation comparing seclusion episodes, duration of close observation, recorded aggressive incidents and data from the Nursing Observed Illness Intensity Scale (NOIIS) on a psychiatric intensive care unit for two three-month periods either side of a move from an old, temporary building to a new, purpose-built ward. The ward environments were also objectively assessed and compared using the Environment Assessment Inventory (EAI).Results: A statistically significant reduction in episodes of seclusion, total seclusion hours and aggressive incidents, as well as a reduction in levels of agitation from the NOIIS data on the new ward compared to the old ward. The EAI scores showed important qualitative improvements on the new ward.Conclusions: This study supports the hypothesis that the physical environment of a psychiatric intensive care unit has a significant impact on levels of arousal and aggression. Established measures of ward environment should be applied to the development and improvement of psychiatric wards.

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Impact of the physical environment of psychiatric wards on the use of seclusion

Abstract: A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint.

Cited by 105 publications

References 32 publications

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Psychiatric staff on the wards does not share attitudes on aggression

A study of agitation, conflict and containment in association with change in ward physical environment

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