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Background Seclusion is an intensive intervention employed in inpatient mental health units to guarantee safety when de-escalation methods have been exhausted. High rate of seclusion are associated with higher employee injury rate, lower staff engagement and increased patient length of stay. Objectives Our aim is to reduce seclusion rates in all admitted patients in inpatient psychiatry from a baseline of 136 to less than 110 per 1000 patient days by December 2016 and sustain for 12 months. Methods A multidisciplinary team developed an Aim and Key Driver Diagram focused on reducing seclusions. Evidence based interventions included milieu management techniques, proactive patient engagement and staff training on trauma informed approaches, physical deflection, and reinforcement principles. Other successful Plan-Do-Study-Act's (PDSA's) include small patient groups and skill-appropriate programming to reduce opportunities for escalating behaviours and increase patient success. Results By 1st quarter 2017, seclusion rates were reduced from 136 to 60 seclusions per 1000 patient days (56% reduction) and sustained for 12 months. In addition to seclusion rates, we achieved a 40% reduction in duration of seclusions, a 55% reduction in mechanical restraints and a 72% reduction in employee injuries. Conclusions Seclusion in children and adolescent mental health units can be significantly reduced through systematic application of quality improvement methodology to revise unit programming and address training and awareness issues. We implemented several effective and less-disruptive interventions while we established a new unit and trained inexperienced staff. These strategies may help impact care of patients in other child and adolescent mental health units.

Despite the difficulties in attempting to generalize about this huge and diverse region, a number of seemingly universal findings appeared in accord with the world literature. These included the widespread use of ECT, its effectiveness and its relative safety despite equally widespread community reluctance.

Background:The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster. Objectives: We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu. Method: This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group (n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group (n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up. Results: Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive. Conclusions: Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted.