Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends

Steinert, Tilman; Lepping, Peter; Bernhardsgrütter, Renate; Conca, Andreas; Hatling, Trond; Janssen, W; Keski-Valkama, Alice; Mayoral, Fermín; Whittington, Richard

doi:10.1007/s00127-009-0132-3

Cited by 319 publications

(282 citation statements)

References 28 publications

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“…In a survey of international trends in the incidence of seclusion and restraint in mental health hospitals, Steinert et al (2010) report mean durations ranging from nine minutes to 1182 hours. In our study, the median duration was 2.83 hours with over 75% of events lasting less than five hours.…”

Section: Discussionmentioning

confidence: 99%

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Oster

Gerace

Thomson³

et al. 2016

Collegian

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Section: Discussionmentioning

confidence: 99%

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Oster

Gerace

Thomson³

et al. 2016

Collegian

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“…In the past decade, the aims of research on aggressive incidents in mental health care institutions have largely been limited to reducing the use of coercive measures (Noorthoorn et al, 2015;Vruwink et al, 2012;Steinert et al, 2010;Raboch et al, 2010;Bowers et al, 2006).…”

Section: Aggressive Incidentsmentioning

confidence: 99%

The influence of dysfunctional impulsivity and alexithymia on aggressive behavior of psychiatric patients

Schutter¹,

Kramer²,

Franken³

et al. 2016

Psychiatry Research

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Current approaches in Dutch mental health care institutions towards inpatients' aggression have focused predominantly on environmental factors, such as training the staff in aggression management. However, personality traits might be an important factor in patients' aggressionas shown by incidents in the wards. This study explores the influence of dysfunctional impulsivity and alexithymia on psychiatric patients' aggressive behavior, through self-reports and through involvement in aggressive incidents. Personality traits influencing patients' aggression emphasize the importance of a more direct approach to their aggression. Clinical patients at Dutch mental health care institution Emergis (n = 84) filled out questionnaires about their aggressiveness (using Buss and Perry's Aggression Questionnaire Short Form), dysfunctional impulsivity and alexithymia. Multiple regression analyses indicated that dysfunctional impulsivity positively related to self-reported aggressive behavior. The relationship, however, could not be confirmed for inpatients' aggression as reported by the staff on the wards. Unexpectedly affective alexithymia negatively related to hostility. Gender differences in self-reported aggression were found. Female patients showed higher levels of hostility. Regression analyses indicated that the male gender positively related to physical aggression. Findings emphasize the importance of a new approach in Dutch mental health care, in which patients may engage in aggression-regulation training programs.

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“…Seclusion and restraint use (SRU) is a frequent intervention in psychiatric settings [1,2,29,30,34]. The literature prior to the year 2000 reports rates ranging from 28% to 60% [1,4,10,15,23].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

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Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in paediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilisation in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1.000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2% to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures.Otherwise, seclusion episodes reduced by 74.7%, including a 32.4%. shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behaviour, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

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Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends

Abstract: Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice.

Cited by 319 publications

References 28 publications

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

The influence of dysfunctional impulsivity and alexithymia on aggressive behavior of psychiatric patients

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

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