Seclusion and Restraint: A Review of Recent Literature

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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“…Dangerous behaviours, towards oneself or others, and agitation or aggression are the most frequently cited reasons for SRU [1,3,4,11,23,27,30].…”

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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“…Cet article examine cette interrogation de deux perspectives : d'une part, l'auteur tente de cerner ce qu'elle traduit de l'expérience des soignants, d'autre part il identifie les enjeux éthiques et juridiques des politiques des programmes de réduction des mesures d'isolement et de contention. (Busch et Shore, 2000), par la réduction de ces atteintes et par le développement des techniques de gestion de la violence les plus respectueuses possible. D'ailleurs, l'identification du problème n'est pas récente.…”

Section: Les Droits Du Patient : Une Menace Pour Les Soignants ?unclassified

“…Le « rapport de force » est donc nettement favorable au personnel soignant (Sjostrom, 2006). L'expérience historique (Busch et Shore, 2000) et la conscience vive que l'inégalité pave la voie aux abus (Kastrup, 2000) appellent une réponse éthico-juridique. Le consensus éthique et juridique (Seicshnaydre, 1992 ;Miller, 1997) est clair : il faut réduire au maximum l'usage de la force à l'égard des patients et minimiser les atteintes aux droits.…”

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Les droits du patient : une menace pour les soignants ?

Keating

2010

smq

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Au cours des dernières années, les groupes de défense des droits des personnes atteintes de troubles mentaux ont obtenu des résultats importants dont l’adoption de politiques de réduction des mesures d’isolement et de contention. Ces politiques témoignent d’un consensus à l’effet que la coercition doit être utilisée uniquement en dernier recours et dans des circonstances exceptionnelles. L’attention grandissante sur les droits des personnes ayant un problème de santé mentale suscite des réactions qui sont très peu abordées dans la littérature. En effet, il n’est pas rare d’entendre les soignants se demander si les patients ne jouissent pas de plus de droits qu’eux-mêmes. Cet article examine cette interrogation de deux perspectives : d’une part, l’auteur tente de cerner ce qu’elle traduit de l’expérience des soignants, d’autre part il identifie les enjeux éthiques et juridiques des politiques des programmes de réduction des mesures d’isolement et de contention.

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“…p.159). Busch & Shore (2000) found that people with 'mental retardation' were more likely to experience restraint and seclusion than many other patient groups. However research on this subject with this population is limited.…”

Section: Secure Services For People With Learning Disabilitiesmentioning

confidence: 99%

Restraint and Seclusion in Services for People with Mental Health Problems and Learning Disabilities: A Literature Review

Isherwood¹

2006

MHLDRP

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This paper reviews the literature pertaining to the practice and experience of restraint and seclusion in inpatient psychiatric settings. These are physical practices typically used by nursing staff in order to manage violence within such services.The available quantitative literature demonstrates the variability in the prevalence of the practices and attitudes towards them. Qualitative research has focussed on the experience of the practices and the different but largely negative impacts they have. Many of these qualitative studies produce interesting and valuable findings; however the literature does not account for the role that language may play in constructing the experience and meaning of the practices for those involved. This and other limitations in the research are described and direction for further research indicated.

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Seclusion and Restraint: A Review of Recent Literature

Cited by 151 publications

References 53 publications

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

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

Les droits du patient : une menace pour les soignants ?

Restraint and Seclusion in Services for People with Mental Health Problems and Learning Disabilities: A Literature Review

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