The Experience of Seclusion and Restraint in Psychiatric Settings: Perspectives of Patients

Abstract

Many studies report that the use of seclusion and restraint (SR) is experienced negatively by patients who experience feelings of shame, helplessness, and humiliation, and may relive previous trauma events. Since 2000, in Québec, exceptional measures like SR have been framed by a protocol. This protocol provides health care teams with guidelines for relieving, containing, and reducing the suffering caused by SR. We have no knowledge, however, about the views of patients regarding application of the protocol. This study aims to understand the perception of patients regarding application of the SR protocol. For this purpose, a questionnaire was presented to patients (n = 50) who experienced an episode of SR in a psychiatric hospital in Canada. Results show that patients had a nuanced perception of SR: Some felt that SR was a helpful measure, while others felt that SR was not a helpful measure. Patients tended to agree with statements related to the comfort and safety of seclusion rooms and the meeting of their physical needs. Regarding support, they suggested relational, drug, and environmental interventions to prevent seclusion. Finally, nearly all patients perceived that the health care team did not follow-up with the patients after the experience; such follow-up is essential for reconstructing a sometimes confusing event.

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“…This theme connects to the theme “protest behaviour,” as patients reported that professionals reacted unnecessarily aggressively, using coercion, when patients’ “protest behaviour” escalated (Knowles et al., ; Ling, Cleverley, & Perivolaris, ; Rose, Evans, Laker, & Wykes, ). Also, patients requested the opportunity to try out other treatments, therapy, strategies or coping skills before coercive measures were initiated (Meehan et al., ; Katsakou et al., ; Kontio et al., ; Faschingbauer et al., ; Larue et al., ; Knowles et al., ).…”

“…“Being subjected to professionals’ control” was characterized by patients’ reported perceptions of being physically and mentally abused (Wynn, ; Haw et al., ; Sibitz et al., ; Knowles et al., ), punished and treated like criminals by the professionals while being coerced (Meehan et al., ; Haglund et al., ; Wynn, ; Chien et al., ; Mayers et al., ; Kontio et al., ; Faschingbauer et al., ; Ling et al., ). Patients felt that their autonomy and rights had been violated (Haglund et al., ; Hoekstra, Lendemeijer, & Jansen, ; Wynn, ; Larue et al., ; Ezeobele et al., ; Larsen & Terkelsen, ; Riley et al., ), and strong feelings of humiliation were reported (Holmes et al., ; Wynn, ; Mayers et al., ; Haw et al., ; Faschingbauer et al., ; Larue et al., ; Van Wijk et al., ; Ling et al., ; Nyttingnes, Ruud, & Rugkasa, ). These experiences were exacerbated by the position of power held by professionals (Meehan et al., ; Haglund et al., ; Hoekstra et al., ; Katsakou et al., ; Kontio et al., ; Faschingbauer et al., ; Ezeobele et al., ; Knowles et al., ).…”

“…Patients reported a great need for “interactions with professionals” during MR, seclusion and restraint (N/D) (Meehan et al., ; Kontio et al., ; Faschingbauer et al., ; Larue et al., ; Ezeobele et al., ; Van Wijk et al., ; Lanthén et al., ), for example, that the professional was physically present during coercion and showed respect (Lanthén et al., ), concern (Haw et al., ; Larue et al., ) and empathy (Van Wijk et al., ). In five studies, patients perceived that professionals provided physical and psychological comfort during coercion (Hoekstra et al., ; Chien et al., ; Larue et al., ; Lanthén et al., ; Ling et al., ). The subtheme “communication” was associated with “positive patient‐perceived impact” and was characterized by patients’ reported perceptions of professional communication during seclusion or MR (Faschingbauer et al., ; Van Wijk et al., ; Lanthén et al., ) when professionals were willing to talk and listen (Van Wijk et al., ) and were informative about the reason for and expected duration of coercion (Faschingbauer et al., ; Lanthén et al., ).…”

Coercion in Forensic Healthcare: A North American Perspective

“…losing credibility, deviating from unit or organisational regulations; Curran 2007). It is concerning that some teams underuse alternatives and relational interventions once SR protocols have been initiated (Larue et al 2009(Larue et al , 2013. Larue et al (2013), furthermore, found that the underlying causes of patient behaviour warranting an SR incident were often unexplored or attributed to a single cause.…”

“…It is concerning that some teams underuse alternatives and relational interventions once SR protocols have been initiated (Larue et al 2009(Larue et al , 2013. Larue et al (2013), furthermore, found that the underlying causes of patient behaviour warranting an SR incident were often unexplored or attributed to a single cause. One American study by Klinge (1994) investigated differences in staff attitudes towards SR use (N ¼ 109); she found that gender and education were important factors in deciding to use SR with acutely psychotic forensic patients.…”