People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Abstract

The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.

Nurse and patient factors: Predicting seclusion in adolescent psychiatric units

“…The behavior subscale on the Health of the Nation Outcome Scales for adults is predictive of seclusion (Jury et al, 2019), but our contrary findings are consistent with those of others who have reported that aggression was not the primary reason for seclusion (Keski-Valkama et al, 2010;Yurtbasi et al, 2016). Adolescents are secluded for different reasons to adults and aggression is complex and defined differently among researchers (Allen et al, 2014;Doedens et al, 2019;Duke et al, 2014).…”

“…Many studies report on the combined risk of seclusion and restraint or a single category of “coercive measures” that includes seclusion, restraint, and pro‐re‐nata/involuntary‐medication (Husum et al, 2010; Steinert et al, 2007; Timbo et al, 2016; Ulla et al, 2012). Psychotic disorders and psychosis, depressive disorders, anxiety disorders, aggression (defined variously as history, risk, and aggressive behaviors), and lower global functioning have all been identified as risk factors for individuals (Doedens et al, 2017; Duke et al, 2014; Dumais et al, 2011; Georgieva et al, 2012; Happell & Koehn, 2010; Jury et al, 2019; Noorthoorn et al, 2015; Swadi & Bobier, 2012; Timbo et al, 2016; Vidal et al, 2020; Vruwink et al, 2012). However, some of these have also shown no effect or the opposite effects on seclusion rates, such as depression acting as a protective factor (Husum et al, 2010; Simpson et al, 2014; Vidal et al, 2020).…”

Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit

“…), and seclusion is typically prompted by aggressive behaviour (Jury et al . ), therefore it would be expected that reductions would be seen in all event types. Nevertheless, these findings are consistent with previous studies that reported reductions in adverse events following the introduction of similar engagement‐based practices on inpatient wards (Bowers et al .…”

“…However, it is possible that the relative infrequency of these events on this ward affected the power to detect statistically significant change. For instance, rates of absconding are associated with increased risk of suicide attempt , and seclusion is typically prompted by aggressive behaviour (Jury et al 2018), therefore it would be expected that reductions would be seen in all event types. Nevertheless, these findings are consistent with previous studies that reported reductions in adverse events following the introduction of similar engagement-based practices on inpatient wards (Bowers et al 2005Dodds & Bowles 2001).…”

Reducing seclusion use for tāngata whai i te ora through integration of Māori culture into practice

“…Seclusion can be likened to being stranded alone on an island, disconnected from resources and any potential help. Studies have shown little or no therapeutic value in the use of seclusion, and it has been proven to both negatively influence welfare and disrupt the therapeutic relationship between consumers and healthcare staff (Mellow et al as cited in Jury et al, 2019;Whitecross, Seeary & Lee, 2013). The purpose of this literature review is to explore the benefits of integrating Māori cultural practices into nursing practice in an acute inpatient setting, and the potential impact this could have on reducing inequities between Māori and non-Māori in regard to the use of seclusion.…”