Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Oster, Candice; Gerace, Adam; Thomson, Del; Muir‐Cochrane, Eimear

doi:10.1016/j.colegn.2015.03.006

Cited by 26 publications

(37 citation statements)

References 30 publications

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“…The findings regarding some consumers being subject to multiple episodes of prolonged restrictive interventions is consistent with the literature (Oster et al . ). Better tailoring of alternative, less‐restrictive interventions towards people exposed to a high number of prolonged events might be an effective means of reducing restrictive interventions (Hendryx et al .…”

Section: Discussionmentioning

confidence: 97%

“…Plans to prevent the use of restrictive interventions should be developed with the person and their family (Oster et al . ).…”

Section: Discussionmentioning

confidence: 97%

“…A small number of consumers, males, and high‐dependency units account for prolonged duration (Oster et al . ). The present state‐wide study was confined to the Australian State of South Australia.…”

Section: Introductionmentioning

confidence: 97%

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Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

McKenna

McEvedy

Maguire

et al. 2017

Int J Mental Health Nurs

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Seclusion and mechanical restraint are restrictive interventions that should be used only as a last resort and for the shortest possible time, yet little is known about duration of use in the broader context. Adult area mental health services throughout Victoria, Australia, were asked to complete a report form for prolonged episodes of seclusion (>8 hours) and mechanical restraint (>1 hour). The present, retrospective cohort study aimed to understand the individual (age, sex, type of service, duration of intervention) and contextual factors associated with prolonged use of restrictive interventions. Contextual factors describing the reasons for prolonged use of the restrictive interventions were captured qualitatively, and then coded using content analysis. Median duration was compared across individual factors using Mann-Whitney U-tests. During 2014, 690 episodes of prolonged restrictive intervention involving 311 consumers were reported. Close to half (n = 320, 46%) involved mechanical restraint. Seclusion episodes (n = 370) were longer in forensic mental health services compared to adult area mental health services (median: 24 hours and 18 min vs 16 hours and 42 min, P < 0.001). Mechanical restraint episodes (n = 320) were shorter in forensic mental health services compared to adult area mental health services (median: 3 hours and 25 min vs 4 hours and 15 min, P = 0.008). Some consumers were subject to multiple episodes of prolonged seclusion (55/206, 27%) and/or prolonged mechanical restraint (31/131, 24%). The most commonly occurring contextual factor for prolonged restrictive interventions was 'risk of harm to others'. Means for reducing the use of prolonged restrictive interventions are discussed in light of the findings.

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Section: Discussionmentioning

confidence: 97%

“…Plans to prevent the use of restrictive interventions should be developed with the person and their family (Oster et al . ).…”

Section: Discussionmentioning

confidence: 97%

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Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

McKenna

McEvedy

Maguire

et al. 2017

Int J Mental Health Nurs

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“…These rates are consistent with recent reports from other Australian states (Oster et al . ). Therefore, there appears to be some evidence of a reduction in the rate of seclusion in Australia as a result of legislation and policy change.…”

Section: Introductionmentioning

confidence: 97%

“…The high degree of conflict and restrictive interventions occurring in inpatient mental health wards has been identified as a significant problem over the past two decades, both in Australia (Australian Human Rights Commision, , Oster et al . ) and around the world (Boumans et al . ; LeBel et al .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

Fletcher

Spittal

Brophy

et al. 2017

Int J Mental Health Nurs

148

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Restrictive practices are used in response to conflict and aggression in psychiatric inpatient settings. Reducing such practices is the focus internationally of policy and legislative change, many initiatives, and a growing body of research. Safewards is a model and a set of 10 interventions designed to reduce conflict and containment in inpatient services. In the current study, we aimed to assess the impact of implementing Safewards on seclusion in Victorian inpatient mental health services in Australia. The study used a before-and-after design, with a comparison group matched for service type. Thirteen wards opted into a 12-week trial to implement Safewards and 1-year follow up. The comparison group was all other wards (n = 31) with seclusion facilities in the jurisdiction, matched to service type. Mandatorily-reported seclusion event data for all 44 wards over a 15-month period were analysed using negative binomial regression. Adherence to Safewards was measured via fidelity checklists at four time points: twice during the trial, post-trial, and at 1-year follow up. Seclusion rates were reduced by 36% in Safewards trial wards by the 12-month follow-up period (incidence rate ratios (IRR) = 0.64,) but in the comparison wards seclusion rates did not differ from baseline to post-trial (IRR = 1.17) or to follow-up period (IRR = 1.35). Fidelity analysis revealed a trajectory of increased use of Safewards interventions after the trial phase to follow up. The findings suggest that Safewards is appropriate for practice change in Victorian inpatient mental health services more broadly than adult acute wards, and is effective in reducing the use of seclusion.

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On Coercion in Inpatient Psychiatric Settings

Rossero

2023

Care in a Time of Crisis

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Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Abstract: Background: Australia is committed to reduce or eliminate the use of containment

Cited by 26 publications

References 30 publications

Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

On Coercion in Inpatient Psychiatric Settings

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