Reduced Frequency of Cases with Seclusion Is Associated with “Opening the Doors” of a Psychiatric Intensive Care Unit

Hochstrasser, Lisa; Voulgaris, Alexander; Möller, Julian; Zimmermann, Tatjana; Steinauer, Regine; Borgwardt, Stefan; Lang, Undine E.; Huber, Christian G.

doi:10.3389/fpsyt.2018.00057

Cited by 23 publications

(17 citation statements)

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“…Due to the rising number of cases treated in the UPK, the percentage of involuntary admission decreased from 13.8% in 2000 (33) to 10.6% in 2013–2015. This might have exerted a positive effect on the mean clinical severity of cases and on the therapeutic atmosphere, further supporting the positive effects of the introduction of an open-door strategy in the hospital (22, 28, 29). In total, the frequency of involuntary admissions in our study is within the range found across Europe, with a minimum of 12.4 per 100,000 inhabitants in Italy and up to 232.5 per 100,000 inhabitants in Finland and with considerable national and regional variations (20, 39).…”

Section: Discussionmentioning

confidence: 70%

“…The Psychiatric University Hospital of Basel-Stadt follows a long-term strategy to promote open-door settings in psychiatry (23) and to decrease compulsory measures and stigmatization (10, 26, 27). Accompanying research could show that in the years 2011 onward, the frequency of seclusion and involuntary treatment could be decreased (22, 28–30) and that therapeutic atmosphere and patient satisfaction could be increased (7, 31) without noticeable detrimental effects on patients’ and public safety and the provision of mental health-care support (32). In addition, a new legal framework concerning involuntary admission was implemented beginning in January 2013.…”

Section: Introductionmentioning

confidence: 99%

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Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

et al. 2019

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Background: When persons with a mental illness present a danger to themselves or others, involuntary hospital admission can be used to initiate an immediate inpatient treatment. Often, the patients have the right to appeal against compulsory admission. These processes are implemented in most mental health-care systems, but regulations and legal framework differ widely. In the Swiss canton of Basel-Stadt, a new regulation was implemented in January 2013. While the current literature holds some evidence for factors associated with involuntary admission, knowledge on who uses the right to appeal against admission is sparse. Aims: The study aims to examine if specific sociodemographic and clinical characteristics are associated with involuntary admission and with an appeal against the compulsory admission order. Method: Routine clinical data of all inpatient cases admitted during the period from January 2013 to December 2015 at the Psychiatric University Hospital Basel were extracted. Generalized estimating equation (GEE) analyses were used to examine the association of sociodemographic and clinical characteristics with “involuntary admission” and “appeal against compulsory admission order.” Results: Of the 8,917 cases included in the present study, 942 (10.6%) were admitted involuntarily. Of these, 250 (26.5%) lodged an appeal against the compulsory admission order. Compared with cases admitted on a voluntary legal status, cases admitted involuntarily were older and were admitted more often during the nighttime or weekend. Moreover, involuntarily admitted cases had more often a principal diagnosis of a schizophrenia spectrum disorder. Patients from cases where an appeal was lodged were more often female, had more often Swiss nationality, and were more often diagnosed with schizophrenia spectrum disorder. Conclusion: Despite legal changes, the frequency of involuntary admissions in the observed catchment area seems to be relatively stable across the last 20 years. The percentage of appeals has decreased from 2000 to 2015, and only comparably few patients make use of the possibility to appeal. Better knowledge of the regulations, higher social functioning, and lower insight into illness might be associated with a higher probability of lodging an appeal. Future research should examine if specific patient groups are in need of additional assistance to exert their rights to appeal.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

et al. 2019

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“…105,106 Two interventions had follow-up studies: Initiatives to Reduce Seclusion and Restraint 107,108 and Open Door Policy. [109][110][111] One intervention (Brøset Violence Checklist [112][113][114] ) had been evaluated in a pilot and a subsequent study. In the case of six interventions (Beacon Project, 115,116 Recovery Based Principles, 6,117 Early Recognition Method, 118,119 REsTRAIN Yourself, 22,85,87,120,121 Scottish Patient Safety Programme for Mental Health 91,[122][123][124] and Talk First 83,86,125,126 ), the multiple records related to the same application or study of that intervention, often in different formats.…”

Section: The Distinction Between Records Standalone Interventions Anmentioning

confidence: 99%

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Baker

Berzins

Canvin

et al. 2021

Health Serv Deliv Res

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Objectives The study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing. Background Incidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content. Design Systematic mapping study and analysis. Data sources English-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo® and PubMed. Databases were searched from 1999 to 2019. Review methods Broad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy. Results The final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques). Limitations Many interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records. Conclusions Studies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways. Future work Prior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery. Study registration The study is registered as PROSPERO CRD42018086985. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

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“…The earliest enquiry was published in 1999, investigating the effect of a token economy on patient behaviour . The majority of papers in this theme were written from 2014 onwards, reporting on changed ward practices and their influence on coercive practices (such as open and closed wards); regulations and guidelines for practice; and different service configurations …”

Section: Resultsmentioning

confidence: 99%

International research into 22 years of use of chemical restraint: An evidence overview

Muir‐Cochrane

Oster

Grimmer

2019

Evaluation Clinical Practice

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Background: Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others.Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice.Aims: To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995.Methods: This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures.Results: This review identified 311 relevant primary studies (21 RCTs; 46 noncontrolled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). Discussion:A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.

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Reduced Frequency of Cases with Seclusion Is Associated with “Opening the Doors” of a Psychiatric Intensive Care Unit

Cited by 23 publications

References 24 publications

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

International research into 22 years of use of chemical restraint: An evidence overview

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