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

Abstract

A B S T R A C TAims: The aim of this review was to assess whether restraint and seclusion are safe and effective interventions for the short-term management of disturbed/violent behaviour. Staff and service user perspectives on the use of these interventions were also considered. The review was undertaken as part of the development process for a national guideline on the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings and emergency departments in the United Kingdom.Method: An exhaustive literature search was undertaken. Systematic reviews, before and after studies, as well as qualitative studies were included. Searches were run from 1985 to 2002.Findings: Thirty-six eligible studies were identified. However, none were randomised controlled trials. Most of the included studies had many limitations, such as small sample sizes, confounders not adequately accounted for, potential selection bias, poorly reported results, and lack of clarity as to whether mechanical restraints were used. This review must therefore be viewed as a mapping exercise, which illustrates the range and quality of studies that have been undertaken in this area to date.Conclusions and Implications for Practice: Insufficient evidence is available to determine whether seclusion and restraint are safe and/or effective interventions for the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings. These interventions should therefore be used with caution and only as a last resort once other methods of calming a situation and/or service user have failed.

Fatal thromboembolic disease: A risk in physically restrained psychiatric patients

“…23,24 While short term physical restraint may have a role in restricted circumstances, 25 the efficacy of prolonged restraint is less certain. [26][27][28][29] We report three cases of sudden death due to thromboembolic disease in psychiatric patients that are directly attributable to prolonged physical restraint. The pathogenesis is presumed to be the result of venous stasis and possibly exacerbated by contributions from the underlying medical condition and/or interventions associated with treatment.…”

Occupational Risk due to Violence in a Psychiatric Ward

“…The above studies however examined the problem of forcible admission from the point of view of its clinical implications rather than from the point of view of the occupational health and safety of the psychiatric ward health care workers. Involuntary admission and treatment should be used with caution and only as a last resort once other methods have failed 15) . Involuntary first admission of patients with schizophrenia is a predictor of future involuntary admissions 16) showing the importance of preventing the vicious circle in which the risk of patients aggressive behavior can increase with involuntary treatment resulting in increased occupational risk for HCWs.…”

Professionals’ Attitudes Toward Reducing Restraint: The Case of Seclusion in The Netherlands

“…Restraint is frequently used in mental health care, despite it remains controversial [1][2][3]. As in many other western countries, also in the Netherlands we see a strong tendency to reduce restraint.…”