The Relationship Between Seclusion and Restraint Use and Childhood Abuse Among Psychiatric Inpatients

Abstract

Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations between childhood trauma and the experience during S/R. Thus, though one would expect to see efforts on the part of inpatient psychiatric facilities to limit S/R of previously abused inpatients, research suggests that trauma victims may be more likely to experience S/R. The current study sought to clarify this possibility by examining whether presence or absence and chronicity of childhood sexual and physical abuse differed among three groups of adult inpatients (N = 622) residing at a mid-Western state psychiatric hospital. These groups are empirically derived on the basis of dramatic differences in the patterning of their exposure to S/R over the course of hospitalization. Results of Chi-square and Kruskal-Wallis tests suggest that the classes did not significantly differ in presence or absence and chronicity of childhood sexual or physical abuse when male and female inpatients were analyzed separately. However, among the class of inpatients who experienced the most instances of S/R, 70% of the members have histories of childhood abuse. Implications for inpatients, clinicians, and policy makers are discussed.

How do mental health services respond when child abuse or neglect become known? A literature review

“…; Hammer et al . ; Substance Abuse and Mental Health Services Administration ), which can be retraumatizing. It was, however, the only review to date to report on the responses of all types of staff to all types of child abuse and neglect.…”

Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital

“…The hospital created a treatment environment that was based on Trauma Informed Care, facilitates recovery, and was inclusive through development of staff education and training. The staff was educated during orientation as new employees, and regularly regarding neurological, biological, psychological, and social effects of trauma, and the prevalence of these experiences in patients receiving mental health services (Delaney, ; Hammer, Springer, Beck, Menditto, & Coleman, ). The principles of recovery‐oriented care, including person‐centered care, respect, dignity, partnerships, and self‐management, became an integral part of the staff trainings.…”

Measuring the impacts of seclusion on psychiatry inpatients and the effectiveness of a pilot single‐session post‐seclusion counselling intervention

“…; Hammer et al . ). According to Litz and Gray (), people are more vulnerable and at substantially increased risk of chronic post‐traumatic stress disorder (PTSD) if previously exposed to a trauma.…”