Seclusion and Restraint

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Introduction
Publications
Research and Practice
Videos and Presentations
Organisations
Links


Introduction

Physical restraint is an extreme response to managing someone’s behaviour when they are in a mental health crisis. It can be humiliating, cause severe distress and at worst it can lead to injury and even death.

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Publications (date ordered)

The Seclusion and Restraint Declaration In 2005, all Australian Governments agreed to act to reduce and where possible to eliminate the use of seclusion and restraint. Despite this, when the National Mental Health Commission was started in 2012, seclusion and restraint was raised time and time again as an issue that people want something done about. It was raised by individuals and their families, and it was raised by services providers and policy makers.Recognising that 45% of Australians will experience a mental health problem in their lifetime – and that the true beneficiaries of reduced seclusion and restraint are people living with mental health problems and those who support them – we invite you to sign up to the declaration below and be part of driving change.

Mental health crisis care: physical restraint in crisis A report on physical restraint in hospital settings in England, Mind, June 2013  This report sets out Mind’s findings on theuse and impact of physical restraint in mental healthcare settings in England. Our research found huge levels of variation across the country in the use of physical restraint, and highlighted the psychological and physical injuries caused as a direct result of being physically restrained.

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Research and Practice

Seclusion and restraint for people with serious mental illnesses Sailas EES, Fenton M, The Cochrane Library 2012, Issue 6 Authors’ conclusions No controlled studies exist that evaluate the value of seclusion or restraint in those with serious mental illness. There are reports of serious adverse effects for these techniques in qualitative reviews. Alternative ways of dealing with unwanted or harmful behaviours need to be developed. Continuing use of seclusion or restraint must therefore be questioned from within well-designed and reported randomised trials that are generalisable to routine practice.

Restraint and seclusion in psychiatric inpatient wards Sailas, Eilaa; Wahlbeck, Kristiana Purpose of review: Despite the controversy over the use of seclusion and restraint, these measures are commonly used to treat and manage disruptive and violent behaviour. This review summarizes recent research on the use of seclusion and restraint, and measures taken to reduce their use. Recent findings: Lately, prominent international recommendations have aimed to restrict the use of seclusion and restraint, and reminded that they should only be used in exceptional cases, where there are no other means of remedying the situation and under the supervision of a doctor. The use of seclusion and restraint has remained prevalent, but there are several innovative programmes that have succeeded in controlling and reducing their use. Staff attitudes about seclusion and restraint have changed little in the last few years.Summary: There is a need for novel methods to treat violence and the threat of violence on psychiatric wards. Violence is a complex phenomenon that needs to be met with a multiprofessional approach. Customer involvement in this work is required. The assessment of the effectiveness of programmes aiming to minimizing seclusion and restraint has been hampered by the lack of parallel control groups and there is a need for cluster-randomized trials. When studying these interventions, the safety of staff and patients should be included as on outcome measure.

Best Practice in the Reduction/Elimination of Seclusion and Restraint;  Seclusion: time for change (2008) by Mary O'Hagan, Divis, M. & Long, J. Published by Te Pou Te Whakaaro Nui: the National Centre of Mental Health Research, Information and Workforce Development, New ZealandReducing the use of seclusion and restraint in mental health service inpatient settings has gained wide national and international interest.  A review of the literature has identified a number of best practices for reducing and eliminating use of seclusion and restraint.  This document outlines these best practices and discusses the new draft Health and Disability Sector Standards that govern use of seclusion and restraint in New Zealand. 

Soteria – no restraint system in Italy Lorenzo Toresini, NEUROLOGIA CROATICA Vol 56, Suppl 5, 2007 The Soteria experience was founded by Loren Mosher in California at the ‘70ies. Soterias were open – no restraint facilities for young psychotic patients, mainly at their onset. Loren Mosher demonstrated that it is possible to treat psychosis also in the acute phase without utilizing restraint methods. In Italy Franco Basaglia began refusing binding patients at their beds in the Lunatic Asylum of Gorizia in the year 1961. He also abolished any isolation method. From this initiative begun a wide theoretical and practical debate in the whole Italy. Restraint started to be considered as an ethical question, rather than as an objective need of public order in the hospital. The whole psychiatric question was seen as a balance between the right to be cured and the defense of society from the disturbing people. It became clear that until then the defense of the society had been prevailing on the right to cure. Such a huge debate led to the endorsement of a national Reform bill in the year 1978, which provided the gradual but radical dismantling and closure of the psychiatric hospitals all over the Country. This process is still being implemented today. The former Psychiatric Hospitals where everywhere substituted by a range of alternative facilities. Mainly outdoors, open facilities, work facilities a. s. f. For those patients who required a hospitalization there have been opened a number (321) small Acute Hospital Wards. The latter can per low guess no more than 15 beds. Even if not everywhere, in many places (30%) such acute wards are run without restraining any patients. In a few of them the ward is run with the door open. At the end it has become clear how dismantling the structures leads to the dismantling of the illness itself.

Interventions for reducing the use of seclusion in psychiatric facilities: Review of the literature Review of the literature CADEYRN J. GASKIN, STEPHEN J. ELSOM, BRENDA HAPPEL, British Journal of Psychiatry,  2007

Force in Mental Health Services: International User / Survivor Perspectives (2003) by Mary O'Hagan.  Keynote Address, World Federation for Mental Health Biennial Congress Melbourne, AustraliaIn this conference keynote address, Mary O'Hagan discusses user/survivor perspectives on the use of force; the history of the user/survivor movement; the position of the movement on the use of force; implications of the use of force; and opportunities to reduce or end the use of force.

Seclusion in New Zealand Mental Health Services Mental Health Commission, NewZealand (2004) This report looks at the use of seclusion in New Zealand up to 2004.  It provides a description of what seclusion is as a form of therapy, containment and punishment. The report provides a description of a two year review of seclusion from human rights in New Zealand.  It provides perspectives from policy and practice, investigating the arguments around human rights, duty of care and therapeutic value.

Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends.

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Videos and Presentations

Force in Mental Health Services: International User / Survivor Perspectives (2003) by Mary O’Hagan. Keynote Address, World Federation for Mental Health Biennial Congress Melbourne, Australia In this conference keynote address, Mary O’Hagan discusses user/survivor perspectives on the use of force; the history of the user/survivor movement; the position of the movement on the use of force; implications of the use of force; and opportunities to reduce or end the use of force. Force Paper

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Organisations

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Links

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