Use of seclusion for managing behavioural disturbance in
                        patients

Newton‐Howes, Giles

doi:10.1192/apt.bp.112.011114

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…The most significant individual risk factors were specific diagnoses and physiological The impact of psychological risk factors, such as aggression and anxious behavior, were less significant. This is important because in seclusion the focus is more on the behavioral disturbance of the patient 28 and less on their physical condition. 29 The contribution of physical risk factors, such as physical impairments and side effects of medication to falls, is significant in both seclusion and in general psychiatric inpatient care.…”

Section: Discussionmentioning

confidence: 99%

Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care

Varpula

Välimäki

Pulkkinen

2022

Journal of Nursing Care Quality

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Background: Patient falls are a major adverse event in psychiatric inpatient care. Purpose: To model the risk for patient falls in seclusion rooms in psychiatric inpatient care. Methods: Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis. Results: The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia. Conclusions: Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.

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Section: Discussionmentioning

confidence: 99%

Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care

Varpula

Välimäki

Pulkkinen

2022

Journal of Nursing Care Quality

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“…Again, restrictions on autonomy are prominent in the setting of inpatient management, and so suitable checks and balances are clearly required and maintained. 31 However, in the case of CTOs, there are opportunities for clinicians to feel satisfied that their actions are ethically preferable (such as through the argument of least restriction), and therefore do not require equivalent scrutiny. And it is not at all clear that this is the case.…”

Section: Restriction Of Autonomy and The “Least Restrictive Argument”mentioning

confidence: 99%

Do Community Treatment Orders in Psychiatry Stand Up to Principalism: Considerations Reflected through the Prism of the Convention on the Rights of Persons with Disabilities

Newton‐Howes¹

2019

J. Law. Med. Ethics

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Compulsory psychiatric treatment is the norm in many Western countries, despite the increasingly individualistic and autonomous approach to medical interventions. Community Treatment Orders (CTOs) are the singular best example of this, requiring community patients to accept a variety of interventions, both pharmacological and social, despite their explicit wish not to do so. The epidemiological, medical/treatment and legal intricacies of CTOs have been examined in detail, however the ethical considerations are less commonly considered. Principlism, the normative ethical code based on the principles of autonomy, beneficence, non-maleficence and justice, underpins modern medical ethics. Conflict exists between patient centred commentary that reflects individual autonomy in decision making and the need for supported decision making, as described in the Convention on the Rights of Persons with Disabilities (CRPD) and the increasing use of such coercive measures, which undermines this principle. What appears to have been lost is the analysis of whether CTOs, or any coercive measure in psychiatric practice measures up against these ethical principles. We consider whether CTOs, as an exemplar of coercive psychiatric practice, measures up against the tenets of principalism in the modern context in order to further this debate.

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“…To our knowledge there are no previous studies exploring incompatibilities between patients in secure psychiatric care; however, the inclusion of incompatibilities is justified because it provides a good indication of interpersonal difficulties with other patients and the management of incompatibilities carries an additional financial cost. There has been considerable attention in the use of seclusions within the context of so called "restrictive interventions" and the use of seclusion remains controversial with ethical, legal and clinical complications (Newton-Howes, 2013). Indeed, the reduction of restrictive interventions is a high priority for inpatient mental health services (Department of Health, 2014;National Institute for Clinical Excellence, 2015).…”

Section: Do Individuals With An Asd Differ From Other Patient Groups In Hspc?mentioning

confidence: 99%

Incompatibilities and seclusion of patients with an autism spectrum disorder detained in high-secure psychiatric care

Murphy

Bush

Puzzo

2017

JIDOB

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Purpose Whilst individuals with an autism spectrum disorder (ASD) represent a relatively small proportion of patients detained in high-secure psychiatric care (HSPC), previous research suggests that such individuals present with difficulties and needs significantly different from non-ASD patient groups. However, to date, there has not been any formal examination of how individuals with an ASD are represented in records of key risk management actions (i.e. seclusions and incompatibilities with other patients). The paper aims to discuss these issues. Design/methodology/approach An observation of hospital data examining two key risk management actions for a group of individuals with an ASD is detained in one HSPC hospital. These include the number of formal incompatibilities with other patients and the number of, and hours in, seclusion. Both actions require extra staff and security provisions and can decelerate the rehabilitation and recovery process. Findings In addition to suggesting an overall increase in the general prevalence of ASD within the hospital compared to previous estimates, individuals with an ASD appear to have a disproportionately higher number of incompatibilities with other patients compared to those patients without an ASD and experience more and longer periods of seclusions. Originality/value Although the methodological limitations of the study are acknowledged, explanations for the findings are discussed along with future research and recommendations as to how ASD patients might be best managed in the hospital. It is argued that the findings add further support for a specialist ASD service within HSPC.

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Use of seclusion for managing behavioural disturbance in patients

Cited by 9 publications

References 22 publications

Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care

Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care

Do Community Treatment Orders in Psychiatry Stand Up to Principalism: Considerations Reflected through the Prism of the Convention on the Rights of Persons with Disabilities

Incompatibilities and seclusion of patients with an autism spectrum disorder detained in high-secure psychiatric care

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