Interventions for reducing the use of seclusion in psychiatric facilities

Abstract

BackgroundThe authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.AimsTo find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.MethodWe reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.ResultsStaff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.ConclusionsReducing seclusion rates is challenging and generally requires staff to implement several interventions.

Is the seclusion policy of mental health care users a necessary evil?

“…Very limited data exist in developing countries. [11,12] This research study reveals seclusion episodes between these two ranges with a mean of 12.5 hours per seclusion episode. The mean hours/month per user of 259 hours represent about 11 (24-hour) days per month which is a lot of time spent in seclusion.…”

Patient Experience of Coercive Measures

“…Globally, there are many programmes to diminish the use of coercion, for example in Finland (National Institute for Health and Welfare 2011), the Netherlands (Abma and Widdershoven 2006;Janssen et al 2008;Vruwink et al 2012), USA (American Psychiatry Association [APA] 2003), and Australia (Australian Government 2008) and Japan (Noda et al 2013). The programmes include as their main elements state-level support, policies and regulations, leadership and culture, educating staff on assessment, treatment planning, documentation, management and early intervention, debriefing, and guidance on restraint and seclusion (APA 2003;Huckshorn 2004;Smith et al 2005;Gaskin et al 2007). Service users are also involved in these programmes, for example in Finland (National Institute for Health and Welfare 2011).…”

Use of seclusion for managing behavioural disturbance in patients

“…In addition, some trials showed significant increases in seclusion rates and no trial has been able to reliably pinpoint the key component(s) that effect positive change. This literature has been reviewed by Gaskin et al (2007), who identified 17 interventions that may lead to reductions in seclusion rates. These fall into three broad spheres: interventions at a policy level, Use of seclusion for managing behavioural disturbance interventions at a hospital level and interventions at an individual (staff) level.…”