When reduction strategies are put in place and mental health consumers are still secluded: An analysis of clinical and sociodemographic characteristics

Abstract

Internationally, seclusion practices continue to be the subject of intense clinical health service and academic scrutiny. Despite extensive efforts to reduce and eliminate this controversial practice, seclusion remains a clinical intervention widely used in contemporary mental health service settings. Early identification of people who are at risk for seclusion and the timely application of alternative evidence-based interventions are critical for reducing incidents of seclusion in real-world practice settings. This retrospective study aimed to determine the relationship between sociodemographic and clinical characteristics, and the use of seclusion for those mental health consumers for whom evidence-based seclusion-reduction initiatives had little impact. A 12-month centred moving average was fitted to seclusion data from a psychiatric inpatient unit over 2 years to determine stabilization in seclusion reduction. The number of consumers admitted was calculated from the point of stabilization for 1 year (n = 469). In this cohort, univariate analysis sought to compare the characteristics of those who were secluded and those who were not. A multivariate logistic regression model was undertaken to associate future seclusion based on significant independent variables. Of those people admitted, 88 (19%) were secluded. The majority of seclusions occurred in the first 5 days (70/88, 79%). Multivariate logistic regression indicated that three variables maintained their independent associative risk of seclusion: (i) age less than 35 years; (ii) assessment of risk of violence to others; and (iii) a history of seclusion. The implications of these findings for nursing practice are discussed.

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

“…Patient seclusion in locked rooms as a violence risk management strategy is widespread, serving as a risk prevention and containment intervention (Landeweer et al., ). Despite attempts to reduce the use of this intervention internationally, one in five inpatients are reportedly secluded at least once in the duration of their hospitalization (Bullock, McKenna, Kelly, Furness, & Tacey, ).…”

“…Despite attempts to reduce the use of this intervention internationally, one in five inpatients are reportedly secluded at least once in the duration of their hospitalization (Bullock, McKenna, Kelly, Furness, & Tacey, 2014).…”

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

“…As with all retrospective cohort studies, the research was limited to the analysis of variables collected, in this case via the form designed by the DHHS for the purpose of monitoring the individual and contextual factors surrounding the prolonged use of restrictive interventions, and we note that the factors reported were not fully reflective of those identified in the literature (Bullock et al 2014). Although the finding that males are more likely to be involved in prolonged duration of restrictive interventions is consistent with the literature (Oster et al 2016), lack of more detailed information about demographics (e.g.…”

Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint

“…Despite overwhelming support for reducing and eliminating the use of seclusion and restraint, and the success of reduction programs, these practices continue to be used in mental health care (Allan et al 2017;Bowers et al 2017;Bullock et al 2014;Gerace et al 2014;Muir-Cochrane et al 2014;Oster et al 2016;Te Pou o te Whakaaro Nui, 2017). Mental health nurses play a central role in the provision of mental health care and as such represent the staff that are most likely to use seclusion and restraint (NMHCCF, 2009).…”