Effects of Ending the Use of Seclusion and Mechanical Restraint in the Pennsylvania State Hospital System, 2011–2020

Smith, Gregory M.; Altenor, Aidan; Altenor, Roberta J.; Davis, Robert H.; Steinmetz, William; Adair, Dale; Ashbridge, Donna M.; Deegan, John A.; Clement, Kristen; Hepner, Marcia; Markley, David B; Smith, Elizabeth W

doi:10.1176/appi.ps.202200004

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…By contrast, a 10-year study across a health system in Pennsylvania found a decrease in the frequency and duration of PR use from 2013 to 2020. 25 However, this study was conducted at relatively few hospitals (n=8) that had a homogenous PR policy and low baseline rate of restraint use (262 of the 100,000 patient days), which may explain the positive findings. Of importance, the declining rate of PR use may have been driven by local interventions within specific homogenous patient populations.…”

Section: Discussionmentioning

confidence: 91%

Physical Restraint Usage in Hospitals Across the United States: 2011-2019

Gupta,

Nelson-Greenberg,

Wright

et al. 2024

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Section: Discussionmentioning

confidence: 91%

Physical Restraint Usage in Hospitals Across the United States: 2011-2019

Gupta,

Nelson-Greenberg,

Wright

et al. 2024

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…The geographical setting was Western countries, i.e., European, Northern America and Australia. Only 10 studies were conducted across more than one hospital (Celofiga et al., 2022; Flammer et al., 2021; Guzman‐Parra et al., 2021; Hamann et al., 2020; Kontio et al., 2014; Shields, 2022; Shields & Busch, 2020; Smith et al., 2023; Stensgaard et al., 2018; Stoll et al., 2022). The inclusion of acute/intensive settings was most often reported in the studies (n = 20) (Badouin et al., 2023; Blair & Moulton‐Adelman, 2015; Celofiga et al., 2022; Cummings et al., 2010; Dixon & Long, 2022; Geoffrion et al., 2018; Goulet et al., 2018; Guzman‐Parra et al., 2015, 2016, 2021; Hamann et al., 2020; Khadivi et al., 2004; Kontio et al., 2014; Lewis et al., 2009; Manning et al., 2022; Steinert et al., 2008; Stoll et al., 2022; Sullivan et al., 2005; Yakov et al., 2018; Yang et al., 2014).…”

Section: Resultsmentioning

confidence: 99%

“…In 23 studies, staff culture changes involved the implementation of complex programmes or approaches, often grounded on the Six Core Strategies (Guzman‐Parra et al., 2016, 2021; Putkonen et al., 2013; Riahi et al., 2016), the Safewards Model (Baumgardt et al., 2019; Lickiewicz et al., 2021; Stensgaard et al., 2018) or other predefined concepts (Geoffrion et al., 2018; Hamann et al., 2020; Lewis et al., 2009). Furthermore, the implementation of different recovery models was reported (Ayres & Tracy, 2021; Blair & Moulton‐Adelman, 2015; Chandler, 2012; Smith et al., 2023; Sullivan et al., 2005). Other approaches were mostly reported to contain independent, concurrent components with varying content, such as staff training and knowledge, case review and rapid response teams (Celofiga et al., 2022; Dike et al., 2021; Dixon & Long, 2022; Godfrey et al., 2014; Khadivi et al., 2004; Kontio et al., 2014; Stoll et al., 2022; Whitecross et al., 2020).…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of and/or time in MR was reduced in all studies, one of which also reported a reverse association for the time in MR for each episode (Guzman‐Parra et al., 2016). Non‐significant findings in relation to changes in MR use were reported in 21 studies (Ayres & Tracy, 2021; Baumgardt et al., 2019; Blair & Moulton‐Adelman, 2015; Celofiga et al., 2022; Chandler, 2012; Dike et al., 2021; Dixon & Long, 2022; Geoffrion et al., 2018; Guzman‐Parra et al., 2016, 2021; Hamann et al., 2020; Kontio et al., 2014; Lewis et al., 2009; Lickiewicz et al., 2021; Putkonen et al., 2013; Riahi et al., 2016; Smith et al., 2023; Stensgaard et al., 2018; Stoll et al., 2022; Sullivan et al., 2005; Whitecross et al., 2020).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings

Pedersen,

Gildberg,

Baker

et al. 2023

Int J Mental Health Nurs

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Mechanical restraint is a commonly used restrictive practice worldwide, although reducing its use is an international priority. Interventions to reduce mechanical restraint are needed if reducing mechanical restraint is to succeed. Therefore, this systematic review aimed to examine evaluated evidence‐based interventions that seek to reduce the incidence of and/or time in mechanical restraint in adult mental health inpatient settings. The JBI framework was used to guide this systematic review. The search strategy included peer‐reviewed primary research literature published between 1999 and 2023. Two authors independently conducted the systematic search, selection process and data extraction process. Forty‐one studies were included in this review. Using content analysis, we grouped interventions into four categories: (I) calm‐down methods, (II) staff resources, (III) legal and policy changes and (IV) changing staff culture. Interventions to reduce mechanical restraint in adult mental health inpatient settings have shown some promise. Evidence suggests that a range of interventions can reduce the incidence of and/or time in mechanical restraint. However, controlled trials were lacking and consensus was lacking across studies. Furthermore, specific findings varied widely, and reporting was inconsistent, hampering the development of interventions for this issue. Further research is needed to strengthen the evidence base for reducing mechanical restraint in mental health inpatient settings.

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“…Several studies have shown that even in these latter settings, eliminating coercion has positive effects. [31][32][33] The WPA Position Statement on Implementing Alternatives to Coercion in Mental Healthcare…”

Section: Who Qualityrights Initiativementioning

confidence: 99%

Bringing together the World Health Organization's QualityRights initiative and the World Psychiatric Association's programme on implementing alternatives to coercion in mental healthcare: a common goal for action

Gill,

Drew,

Rodrigues

et al. 2024

BJPsych open

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Background Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO's QualityRights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare. Aims We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO's approach to eliminate coercion and the WPA's goal to implement alternatives to coercion. Method We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes. Results Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors. Conclusions We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.

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Effects of Ending the Use of Seclusion and Mechanical Restraint in the Pennsylvania State Hospital System, 2011–2020

Cited by 8 publications

References 17 publications

Physical Restraint Usage in Hospitals Across the United States: 2011-2019

Physical Restraint Usage in Hospitals Across the United States: 2011-2019

A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings

Bringing together the World Health Organization's QualityRights initiative and the World Psychiatric Association's programme on implementing alternatives to coercion in mental healthcare: a common goal for action

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