Restraint and seclusion in psychiatric inpatient wards

Abstract

There is a need for novel methods to treat violence and the threat of violence on psychiatric wards. Violence is a complex phenomenon that needs to be met with a multiprofessional approach. Customer involvement in this work is required. The assessment of the effectiveness of programmes aiming to minimizing seclusion and restraint has been hampered by the lack of parallel control groups and there is a need for cluster-randomized trials. When studying these interventions, the safety of staff and patients should be included as on outcome measure.

Violent Behavior in Acute Psychiatric Inpatient Facilities

“…Physical restraint use increased, however, in function of the severity of patients' aggressive acts. These data seem to confirm that physical restraint remains a common aggression management practice in psychiatric inpatient units, especially for severe episodes (Fisher, 1994;Sailas and Wahlbeck, 2005). This finding also underscores a need to develop optimal, standard programs aimed at assessing, preventing, and effectively treating violent psychiatric inpatients (Khadivi et al, 2004;Sailas and Wahlbeck, 2005;Migon et al, 2008).…”

Professionals’ Attitudes Toward Reducing Restraint: The Case of Seclusion in The Netherlands

“…Research is particularly important for the presumption of relationships between deep change and a reduction in seclusion. Longitudinal studies into the functioning of professionals within various practices of restraint are necessary in order to examine the tenability of this proposal in the future and to arrive at conclusions on the possibilities and chances of a reduction in restraint in psychiatric institutions [11].…”

“…Even if the majority of these projects seem to be successful in reducing restraint [8], the total number of restraints in Dutch health care sector has yearly increased rather than decreased [9]. This disappointing result is not just a Dutch phenomenon, but seems to be typical for most western countries [10,11]. One obvious explanation is the willingness of professionals to change their own practice.…”

When Is Antipsychotic Polypharmacy Supported by Research Evidence? Implications for QI

“…It is unlikely that even the most evidence-based, conscientious, and effective inpatient units will achieve perfect performance on even the second measure, any more than adult inpatient units can truly reduce restraint rates to zero if they admit agitated, assaultive psychotic patients. However, just as many facilities, including state mental health systems, have achieved significant decreases in physical restraint use through education, training, innovative procedures, and enhanced communication, 78,79 it is likely that inpatient teams can also reduce the rate of unnecessary antipsychotic polypharmacy.…”