title: Mental health service users' perceptions and experiences of sedation, seclusion and restraint.
abstract: BACKGROUND
  Sedation, seclusion or restraint are recognized methods of containing a person experiencing an acute psychotic episode with behavioural disturbance which has not responded to verbal or non-sedating pharmacological interventions. These interventions pose significant ethical and practical challenges to service providers who are responsible for safeguarding the human rights of mental health service users.
  
  
  OBJECTIVE
  In a collaborative two-phase study between mental health care providers and mental health service users, the perceptions and experiences of a group of service users who have been exposed to sedation, seclusion and restraint were explored.
  
  
  METHODS
  A focus group was conducted with eight service users. The content of the focus group was transcribed and themes were identified using thematic analysis. These were presented to a second focus group consisting of eight other service users for validation and comment. Based on the results of the focus groups, a questionnaire was developed and administered to a convenience sample of 43 service users in three localities.
  
  
  RESULTS
  Service users reported inadequate communication between them and service providers and perceived that their human rights had been infringed during acute episodes of illness.
  
  
  METHODS
  of containment were often seen as punitive rather than therapeutic. Sedation was most frequently used and was considered to be least distressing. Observing methods of forced/involuntary containment caused further distress.
  
  
  CONCLUSIONS
  There is a need to humanize service users' experiences during episodes of acute illness. Measures should include prevention of human rights abuses; minimization of isolation and distress; improvement of communication between service providers and service users; and promotion of attitudinal changes which reflect respect for other people's dignity.
authors.affiliation: Division of Nursing and Midwifery, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa. Pat.Mayers@uct.ac.za
authors.forename: Pat
authors.initials: P
authors.lastname: Mayers
authors.forename: Nelleke
authors.initials: N
authors.lastname: Keet
authors.forename: Gunter
authors.initials: G
authors.lastname: Winkler
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Flisher
mesh_terms: D000208:Acute Disease; D000328:Adult; D003142:Communication; D016292:Procedural Sedation / Q000523:psychology*; D003688:Deinstitutionalization; D004637:Emergency Services, Psychiatric; D005260:Female; D017144:Focus Groups; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010344:Patient Advocacy / Q000523:psychology*; D010356:Patient Isolation / Q000523:psychology*; D010865:Pilot Projects; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D011678:Punishment; D012149:Restraint, Physical / Q000523:psychology*; D012931:Social Environment; D012944:Social Support; D013019:South Africa