Recovery-based services in a psychiatric intensive care unit – the consumer perspective

Increasing efforts are being made to prevent and/or eliminate the use of seclusion and restraint in mental health facilities. Recent literature recognises the importance of the physical environment in supporting better outcomes in mental health services. This rapid review scoped the existing literature studying what physical design features of mental health facilities can reduce the use of seclusion and physical restraint.DesignA rapid review of peer-reviewed literature.MethodsPeer-reviewed literature was searched for studies on architectural design and the use of restraint and seclusion in mental health facilities. The following academic databases were searched: Cochrane Library, Medline, PsycINFO, Scopus and Avery for English language literature published between January 2010 and August 2019. The Joanna Briggs Institute’s critical appraisal tool was used to assess the quality of included studies.ResultsWe identified 35 peer-reviewed studies. The findings revealed several overarching themes in design efforts to reduce the use of seclusion and restraint: a beneficial physical environment (eg, access to gardens or recreational facilities); sensory or comfort rooms; and private, uncrowded and calm spaces. The critical appraisal indicated that the overall quality of studies was low, as such the findings should be interpreted with caution.ConclusionThis study found preliminary evidence that the physical environment has a role in supporting the reduction in the use of seclusion and restraint. This is likely to be achieved through a multilayered approach, founded on good design features and building towards specific design features which may reduce occurrences of seclusion and restraint. Future designs should include consumers in a codesign process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience expertise.

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“…In total, 35 publications were included in this review 4 6 23-55 which reported on seclusion, 23 56 is reported in figure 1.…”

Section: Included Studiesmentioning

confidence: 99%

Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review

et al. 2021

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“…From the patients’ perspective, recovery‐based and person‐centred care can provide useful theoretical frameworks relevant for sensory rooms on psychiatric wards, including the concept of being a ‘person’, the importance of the care environment, choice and responsibility, risk awareness and management, as well as different forms of knowing (Ash et al . ; Björkdahl et al . ; McCormack & McCance ).…”

Section: Introductionmentioning

confidence: 99%

The experiences of patients in using sensory rooms in psychiatric inpatient care

Lindberg

Samuelsson

Perseius

et al. 2019

Int J Mental Health Nurs

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The use of sensory rooms and similar sensory approaches in psychiatric inpatient settings is becoming increasingly common. In sensory rooms, patients can choose different sensory stimulating items that may help regulate distress and enhance well-being. Outcomes are often measured as effects on patients' self-rated distress and rates of seclusion and restraint. The subjective experiences of patients using sensory rooms have been less explored. This paper presents a qualitative study of the experiences of 28 patients who chose to use sensory rooms on seven different types of psychiatric inpatient wards. Data were collected by individual patient interviews and by texts written by patients. A qualitative content analysis resulted in four categories: emotional calm, bodily calm, empowerment, and unexpected effects. A majority of the participants described several positive experiences, such as enhanced well-being, reduced anxiety, increased self-management, and enhanced self-esteem. Our findings align with previous research that has shown similar positive patient experiences, and support the use of sensory rooms as part of person-centred care.

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“…Although the value of engagement in meaningful and enjoyable activities in hyperacute settings has been highlighted by numerous authors (Ash et al ., ; Best, ; Gwinner & Ward, ; Salzmann‐Erikson et al ., ; Sullivan et al ., ), previous studies have not attempted to describe the types of activities that might be most suitable for individuals admitted to these units. As was described in the introduction, ‘typical’ occupational therapy groups and activities used in general acute settings may not be appropriate for individuals experiencing high levels of acute symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Although the practice description provided by Best (1996) is very useful, it is based predominantly on one person's experience and provides only anecdotal information. Other literature also supports the importance of occupational therapy or meaningful activities in the context of PICUs or HDUs (Ash, Suetan, Nair & Halpin, 2015;Gwinner & Ward, 2014;Pereira & Woollaston, 2007;Salzmann-Erikson, L€ utz en, Ivarsson & Eriksson, 2011;Sullivan et al, 2004), but there is very little specific information about the types of activities that are helpful or specific approaches that should be taken by occupational therapists in these settings. This lack of specificity is consistent with findings from Crowhurst and Bowers (2002) who reported that there was a lack of specific intervention guidelines for treatment approaches in PICUs.…”

Section: Evidence For Occupational Therapy In Picus and Hdusmentioning

confidence: 99%

“…This lack of specificity is consistent with findings from Crowhurst and Bowers () who reported that there was a lack of specific intervention guidelines for treatment approaches in PICUs. In general, the benefits of meaningful activities in the context of PICUs and HDUs have been described as: (i) improving the consumer experience, (ii) promoting more supportive relationships between staff and consumers, (iii) providing daily structure, (iv) minimising aggression related to boredom and (v) assisting services to become more recovery oriented, shifting from a culture of ‘control’ to a culture of care (Ash et al .; Gwinner & Ward; Pereira & Woollaston; Salzmann‐Erikson et al .; Sullivan et al .).…”

Section: Introductionmentioning

confidence: 99%

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Exploring consumer functioning in High Dependency Units and Psychiatric Intensive Care Units: Implications for mental health occupational therapy

et al. 2016

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This study provides the first description of functional abilities of consumers admitted to an HDU and PICU. Results were used to develop an initial conceptualisation of 'stages' of regaining functional abilities and a set of initial guidelines to support targeted occupational therapy interventions. This study will contribute to a better understanding of the functional abilities of individuals admitted to HDUs and PICUs and will support the development of optimal occupational therapy interventions in these settings.

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Recovery-based services in a psychiatric intensive care unit – the consumer perspective

Abstract: Recovery principles can be successfully introduced in a psychiatric intensive care unit environment. Introduction of recovery based practice was associated with a reduction in seclusion.

Cited by 21 publications

References 8 publications

Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review

Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review

The experiences of patients in using sensory rooms in psychiatric inpatient care

Exploring consumer functioning in High Dependency Units and Psychiatric Intensive Care Units: Implications for mental health occupational therapy

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