Predictors of the use of restraint and seclusion in public psychiatric hospitals

Is there racial bias in clinicians' perceptions of the dangerousness of psychiatric patients? A review of the literature

“…The authors suggest that high numbers of young, black patients may therefore account for apparent racial bias (Carpenter et al, 1988). A similar result was reported in a replication of this study (Forquer et al, 1996).…”

“…A diagnosis of mania has been found to be a significant factor in predicting likelihood of being secluded (Forquer et al, 1996). However schizophrenia, which is reported as being commonly over diagnosed in black patients (Littlewood & Lipsedge, 1981) has not been found to distinguish between secluded and non-secluded groups of black patients (Soloff & Turner, 1981).…”

“…This not only makes direct comparisons between different studies difficult, but may also obscure the effect (if any) of a relationship between race and judgements of dangerousness. For example, the use of seclusion may be indicated for a number of therapeutic reasons, such as reducing external stimulation of patients with mania or bipolar disorder (Forquer et al, 1996). They suggest that seclusion rates of white patients may therefore be elevated as a result of diagnostic issues, since black patients may be less likely than white to receive a diagnosis of an affective disorder.…”

Organizational and Unit Factors Contributing to Reduction in the Use of Seclusion and Restraint Procedures on an Acute Psychiatric Inpatient Unit

“…The impact of patient census is also unclear, with some evidence suggesting that the use of S/R increases when the census is high [16] or when overcrowding is present [17], and other evidence suggesting that the use of S/R is higher when the census is low [18] or that S/R is unrelated to census [19]. Similarly, results regarding the relation between length of stay and the use of S/R are inconsistent, with evidence suggesting S/R is more frequent with shorter lengths of stay [20,21], longer lengths of stay [16,22,23], or is unrelated to length of stay [24].…”

Decreasing the Use of Restraint and Seclusion Among Psychiatric Inpatients

“…[15][16][17] While some studies have linked specific patient characteristics (diagnosis, length of stay, age, race, and gender) to the risk of restraint and seclusion, [18][19][20][21] these findings are inconsistent, and other studies have failed to find any association between clinical or demographic variables and rates of restraint and seclusion. 17,[22][23][24] Rates of restraint and seclusion may be affected by differences in hospital characteristics independent of patient population, 25 including geographical location, 25,26 size, 15 and patient-to-staff ratio. 27 Several authors have described efforts to reduce rates of restraint and seclusion, 10,16,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] mostly in urban psychiatric hospitals, in adult 10,[28][29][30][31][32][33][39][40][41][42] or adolescent [34]…”