Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

Abstract

Seclusion and mechanical restraint are restrictive interventions that should be used only as a last resort and for the shortest possible time, yet little is known about duration of use in the broader context. Adult area mental health services throughout Victoria, Australia, were asked to complete a report form for prolonged episodes of seclusion (>8 hours) and mechanical restraint (>1 hour). The present, retrospective cohort study aimed to understand the individual (age, sex, type of service, duration of intervention) and contextual factors associated with prolonged use of restrictive interventions. Contextual factors describing the reasons for prolonged use of the restrictive interventions were captured qualitatively, and then coded using content analysis. Median duration was compared across individual factors using Mann-Whitney U-tests. During 2014, 690 episodes of prolonged restrictive intervention involving 311 consumers were reported. Close to half (n = 320, 46%) involved mechanical restraint. Seclusion episodes (n = 370) were longer in forensic mental health services compared to adult area mental health services (median: 24 hours and 18 min vs 16 hours and 42 min, P < 0.001). Mechanical restraint episodes (n = 320) were shorter in forensic mental health services compared to adult area mental health services (median: 3 hours and 25 min vs 4 hours and 15 min, P = 0.008). Some consumers were subject to multiple episodes of prolonged seclusion (55/206, 27%) and/or prolonged mechanical restraint (31/131, 24%). The most commonly occurring contextual factor for prolonged restrictive interventions was 'risk of harm to others'. Means for reducing the use of prolonged restrictive interventions are discussed in light of the findings.

Implementing seclusion in forensic mental health care: A qualitative study of staff decision making

“…The participants described how seclusion should be used as a last resort and these views were entirely congruent with the literature (Mayor, 2005;McKenna et al, 2017). However, on a different note an interesting perspective is provided by Haw, Stubbs, Bickle and Stewart (2011) who studied patient's preferences and noted that coercive measures can undermine the therapeutic relationship with patients.…”

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

“…However, seclusion, physical, and mechanical restraint remain relatively common practices, with recent studies highlighting concerning factors such as the use of these practices multiple times with the same consumers (Oster et al . ) or for prolonged periods of time (McKenna et al ., ). This highlights an urgent need to better understand the use of these practices and experiences of staff working with mental health consumers in inpatient settings and EDs.…”

What factors influence the decisions of mental health professionals to release service users from seclusion?

“…McKenna et al . () suggested prolonged durations in seclusion in forensic services are more likely associated with clinical presentation, whereas adult mental health is more likely influenced by contextual factors. Nevertheless, findings may be of general interest to mental health professionals working in inpatient environments or services implementing restraint reduction programmes.…”