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Interventions for reducing the use of seclusion in psychiatric facilities

Review of the literature

Centre for Psychiatric Nursing, University of Melbourne, Victoria, Australia

Correspondence: Dr C. J.Gaskin, Centre for Psychiatric Nursing, University of Melbourne, Level 1, 723 Swanston Street, Carlton, Victoria 3053, Australia. Email: cjgaskin{at}unimelb.edu.au

Declaration of interest None.

Background The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

Aims To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

Method We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Results Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Conclusions Reducing seclusion rates is challenging andgenerally requires staff to implement several interventions.

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Highlights of this issue

KIMBERLIE DEAN
BJP 2007 191: 279-a13-279. [Full Text]  

PETER TYRER
BJP 2007 191: 372. [Full Text]  

This article has been cited by other articles:

				P. Tyrer From the Editor's desk The British Journal of Psychiatry, July 1, 2008; 193(1): 90 - 90. [Full Text] [PDF]

				J. G. Scott and A. Dean Tailoring seclusion policies to the patient group The British Journal of Psychiatry, March 1, 2008; 192(3): 232 - 232. [Full Text] [PDF]

				C. J. Gaskin, S. J. Elsom, and B. Happell Authors' reply: The British Journal of Psychiatry, March 1, 2008; 192(3): 232 - 232. [Full Text] [PDF]

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