Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature.
BACKGROUND
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 programmes. 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/debriefing; (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 programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment.


CONCLUSIONS
The development of new seclusion and restraint reduction programmes 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.
Scanlan
Justin Newton
JN
Concord Centre for Mental Health, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia. justin.scanlan@email.cs.nsw.gov.au
D001521:Behavior Therapy / Q000193:education / Q000458:organization & administration / Q000639:trends; D015928:Cognitive Behavioral Therapy / Q000193:education / Q000458:organization & administration / Q000639:trends; D003419:Crisis Intervention / Q000193:education / Q000458:organization & administration / Q000639:trends; D005544:Forecasting; D006284:Health Plan Implementation / Q000458:organization & administration / Q000639:trends*; D006291:Health Policy / Q000639:trends*; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000639:trends; D006778:Hospitals, Psychiatric / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration / Q000639:trends; D007857:Leadership; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D009517:New South Wales; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration / Q000639:trends; D010356:Patient Isolation / Q000458:organization & administration / Q000523:psychology / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000523:psychology / Q000639:trends; D011368:Professional-Family Relations; D012149:Restraint, Physical / Q000523:psychology / Q000706:statistics & numerical data*; D012931:Social Environment