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Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far. A review of the literature.

Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia

^* To whom correspondence should be addressed. E-mail: justin.scanlan{at}email.cs.nsw.gov.au.

	Abstract

Introduction: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction pro-grammes. A total of 29 papers were included in the review.

Results: Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefi ng; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction pro-grammes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment.

Conclusion: The development of new seclusion and restraint reduction pro-grammes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.

First published on July 17, 2009
International Journal of Social Psychiatry 2009, doi:10.1177/0020764009106630


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