Seclusion and Restraint in Psychiatry: Patients' Experiences and Practical Suggestions on How to Improve Practices and Use Alternatives

Abstract

Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development.

Regulation as an Obstacle to Care? A Care-Ethical Evaluation of the Regulation on the Use of Seclusion Cells in Psychiatric Care in Flanders (Belgium)

“…In the event of seclusion, however, patients must often hand them over for safety reasons (Kontio et al 2012). In Flanders, Belgium, there are no external rules on patients' rights during seclusion (see Put et al 2003), and the inspection authority rarely looks into the content of hospital procedures.…”

Consumers’ and their supporters’ perspectives on barriers and strategies to reducing seclusion and restraint in mental health settings

“…1 In Australia, serious concerns about the use of seclusion and restraint in mental health care have been raised at least since 1993, 2 and in 2005 all Australian health ministers agreed to reduce the use of seclusion and restraint. 3 Several studies have noted adverse consequences for those subjected to seclusion and mechanical restraint [4][5][6][7][8][9] and raised concerns with human rights breaches. 10 Many mental health practitioners, consumers and family members, friends and other supporters (supporters) have also embraced the aim to reduce and, where possible, eliminate seclusion and restraint.…”

Directions for Future Patient-Centered and Comparative Effectiveness Research for People With Serious Mental Illness

“…110 Researchers are just beginning to explore the unintended consequences of the use of coercion, leverage, seclusion, and restraint, and the more widespread tacit and deliberate pressures to comply with providers or accede to treatment other than one's choice. Kontio et al 102 elicited first-person accounts of seclusion and restraint from psychiatric patients that are both alarming and informative. While the EUNOMIA and MacArthur projects have begun to provide needed data, it is crucial that research of this type be launched in collaboration with mental health service users.…”

“…102 The ethics of these practices have been questioned, as has their legality, therapeutic value, and effectiveness. 74,103 Muralidharan and Fenton 104 reviewed the effectiveness of nonpharmacological forms of containment-including special observation, locked units and rooms, deescalation, and behavioral contracts-and concluded that there was insufficient evidence to support these practices.…”