Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T05:52:42.420Z Has data issue: false hasContentIssue false
  • English
  • Français

Innovation and pragmatism required to reduce seclusion practices

Published online by Cambridge University Press:  28 October 2016

John Tully ,
Leo McSweeney ,
Katie-Lynn Harfield ,
Cindie Castle  and
Mrigendra Das
John Tully*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry and South London and Maudsley Foundation Trust, London, UK
Leo McSweeney
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
Katie-Lynn Harfield
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
Cindie Castle
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
Mrigendra Das
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
*
*Address for correspondence: Dr. John Tully, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, 16 De Crespigny Park, Camberwell, London SE5 8AF, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Seclusion may be harmful and traumatic to patients, detrimental to therapeutic relationships, and can result in physical injury to staff. Further, strategies to reduce seclusion have been identified as a potential method of improving cost-effectiveness of psychiatric services. However, developing alternative strategies to seclusion can be difficult. Interventions to reduce seclusion do not lend themselves to evaluation using randomized controlled trials (RCTs), though comprehensive literature reviews have demonstrated considerable non-RCT evidence for interventions to reduce seclusion in psychiatric facilities. In the UK, a recent 5-year evaluation of seclusion practice in a high secure UK hospital revealed reduced rates of seclusion without an increase in adverse incidents. To assess the effect of a novel intervention strategy for reduction of long-term segregation on a high secure, high dependency forensic psychiatry ward in the UK, we introduced a pilot program involving stratified levels of seclusion (“long-term segregation”), multidisciplinary feedback and information sharing, and a bespoke occupational therapy program. Reduced seclusion was demonstrated and staff feedback was mainly positive, indicating increased dynamism and empowerment on the ward. A more structured, stratified approach to seclusion, incorporating multidisciplinary team-working, senior administrative involvement, dynamic risk assessment, and bespoke occupational therapy may lead to a more effective model of reducing seclusion in high secure hospitals and other psychiatric settings. While lacking an evidence base at the level of RCTs, innovative, pragmatic strategies are likely to have an impact at a clinical level and should guide future practice and research.

Keywords

Information sharingmultidisciplinary feedbacknonpharmacological interventionsoccupational therapyrelational securitystaff educationsupervised confinement
Type
Opinion
Information
CNS Spectrums , Volume 21 , Issue 6 , December 2016 , pp. 424 - 429
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The authors would like to acknowledge the input and experience of all nursing staff on the ward and all allied health professionals, without whose efforts this project would not have been possible.

References

1. Knox, DK, Holloman, GH Jr. Use and avoidance of seclusion and restraint: consensus statement of the american association for emergency psychiatry project Beta seclusion and restraint workgroup. West J Emerg Med. 2012; 13(1): 35–40.CrossRefGoogle Scholar
2. Department of Health, England. Code of practice Mental Health Act 1983; published August 1993 pursuant to Section 118 of the Act: London: HMSO; 1993.Google Scholar
3. Khadivi, AN, Patel, RC, Atkinson, AR, Levine, JM. Association between seclusion and restraint and patient-related violence. Psychiatr Serv. 2004; 55(11): 1311–1312.CrossRefGoogle ScholarPubMed
4. Happell, B, Harrow, A. Nurses’ attitudes to the use of seclusion: a review of the literature. Int J Ment Health Nurs. 2010; 19(3): 162–168.CrossRefGoogle Scholar
5. Nelstrop, L, Chandler‐Oatts, J, Bingley, W, et al. A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short‐term management of violence in adult psychiatric inpatient settings and emergency departments. Worldviews Evid Based Nurs. 2006; 3(1): 8–18.CrossRefGoogle ScholarPubMed
6. Morrall, P, Muir-Cochrane, E. Naked social control: seclusion and psychiatric nursing in post-liberal society. Australian e-Journal for the Advancement of Mental Health. 2002; 1(2): 101–112.CrossRefGoogle Scholar
7. Frueh, BC, Knapp, RG, Cusack, KJ, et al. Special section on seclusion and restraint: patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv. 2005; 56(9): 1123–1133.CrossRefGoogle ScholarPubMed
8. Bonner, G, Lowe, T, Rawcliffe, D, Wellman, N. Trauma for all: a pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. J Psychiatr Ment Health Nurs. 2002; 9(4): 465–473.CrossRefGoogle ScholarPubMed
9. Martin, A, Krieg, H, Esposito, F, Stubbe, D, Cardona, L. Reduction of restraint and seclusion through collaborative problem solving: a five-year prospective inpatient study. Psychiatr Serv. 2008; 59(12): 1406–1412.CrossRefGoogle ScholarPubMed
10. Boumans, CE, Egger, JI, Souren, PM, Hutschemaekers, GJ. Reduction in the use of seclusion by the methodical work approach. Int J Ment Health Nurs. 2014; 23(2): 161–170.CrossRefGoogle ScholarPubMed
11. Qurashi, I, Johnson, D, Johnson, B. Reduction in the use of seclusion in a high secure hospital in the UK: a retrospective analysis. BMC Psychiatry. 2007; 7(1): 1.CrossRefGoogle Scholar
12. Strumpf, NE, Tomes, N. Restraining the troublesome patient. A historical perspective on a contemporary debate. Nurs Hist Rev. 1993; 1: 3–24.CrossRefGoogle Scholar
13. Steinert, T, Lepping, P, Bernhardsgrütter, R, et al. Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Soc Psychiatry Psychiatr Epidemiol. 2010; 45(9): 889–897.CrossRefGoogle ScholarPubMed
14. Steel, E. Seclusion and Restraint Practice Standards. Alexandria, VA: National Mental Health Association, Consumer Support Technical Assistance Center; 1999.Google Scholar
15. Muralidharan, S, Fenton, M. Containment strategies for people with serious mental illness. Cochrane Database Syst Rev. 2006;(3): CD002084.Google ScholarPubMed
16. Putkonen, A, Kuivalainen, S, Louheranta, O, et al. Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. Psychiatr Serv. 2013; 64(9): 850–855.CrossRefGoogle ScholarPubMed
17. Bergk, J, Einsiedler, B, Steinert, T. Feasibility of randomized controlled trials on seclusion and mechanical restraint. Clin Trials. 2008; 5(4): 356–363.CrossRefGoogle ScholarPubMed
18. Gaskin, CJ, Elsom, SJ, Happell, B. Interventions for reducing the use of seclusion in psychiatric facilities. Br J Psychiatry. 2007; 191(4): 298–303.CrossRefGoogle ScholarPubMed
19. Stewart, D, Van der Merwe, M, Bowers, L, Simpson, A, Jones, J. A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues Ment Health Nurs. 2010; 31(6): 413–424.CrossRefGoogle ScholarPubMed
20. Donat, DC. An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatr Serv. 2003; 54(8): 1119–1123.CrossRefGoogle Scholar
21. Smith, GM, Davis, RH, Bixler, EO, et al. Special section on seclusion and restraint: Pennsylvania State Hospital System’s seclusion and restraint reduction program. Psychiatr Serv. 2005; 56(9): 1115–1122.CrossRefGoogle Scholar
22. Department of Health, England. Commissioning for Quality and Innovation 2015/16 (CQUIN) Pack for Specialised Services. Leeds: Department of Health. 2015: 13.Google Scholar
23. Huckshorn, K. Reducing the use of seclusion and restraint: A national initiative toward culture change and transformation. Presentation. 2005. http://www.paproviders.org/archives/Pages/Childrens_Archive/Reducing_Seclusion_and_Restraint_2005.pdf.Google Scholar
24. Wale, JB, Belkin, GS, Moon, R. Reducing the use of seclusion and restraint in psychiatric emergency and adult inpatient services: Improving patient-centered care. Perm J. 2011; 15(2): 57–62.CrossRefGoogle ScholarPubMed
25. Ashcraft, L, Anthony, W. Eliminating seclusion and restraint in recovery-oriented crisis services. Psychiatr Serv. 2008; 59(10): 1198–1202.CrossRefGoogle ScholarPubMed
26. OT-Innovations.com. Seclusion and Restraint Reduction Initiative. 2015. http://www.ot-innovations.com/restraint-reduction/seclusion-and-restraint-reduction-initiative/. Accessed March 6, 2016.Google Scholar
27. Van der Merwe, M, Bowers, L, Jones, J, Muir-Cochrane, E, Tziggili, M. Seclusion: A Literature Review. Report from the Conflict and Containment Reduction Research Programme. London: City University London; 2009. http://www.kcl.ac.uk/ioppn/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevSeclusion.pdf.Google Scholar
28. Withers, P, Boulton, N, Morrison, J, Jones, A. Occupational therapy in a medium secure intellectual disability and personality disorder service. Journal of Learning Disabilities and Offending Behaviour. 2012; 3(4): 206–218.CrossRefGoogle Scholar