Acceptability and use of coercive methods across differing service configurations with and without seclusion and/or psychiatric intensive care units.
OBJECTIVE
The aim of this study was to compare across different service configurations the acceptability of containment methods to acute ward staff and the speed of initiation of manual restraint.


BACKGROUND
One of the primary remits of acute inpatient psychiatric care is the reduction in risks. Where risks are higher than normal, patients can be transferred to a psychiatric intensive care unit or placed in seclusion. The abolition or reduction in these two containment methods in some hospitals may trigger compensatory increases in other forms of containment which have potential risks. How staff members manage risk without access to these facilities has not been systematically studied.


METHODS
The study applied a cross-sectional design.


METHODS
Data were collected from 207 staff at eight hospital sites in England between 2013 - 2014. Participants completed two measures; the first assessing the acceptability of different forms of containment for disturbed behaviour and the second assessing decision-making in relation to the need for manual restraint of an aggressive patient.


RESULTS
In service configurations with access to seclusion, staff rated seclusion as more acceptable and reported greater use of it. Psychiatric intensive care unit acceptability and use were not associated with its provision. Where there was no access to seclusion, staff were slower to initiate restraint. There was no relationship between acceptability of manual restraint and its initiation.


CONCLUSIONS
Tolerance of higher risk before initiating restraint was evident in wards without seclusion units. Ease of access to psychiatric intensive care units makes little difference to restraint thresholds or judgements of containment acceptability.
Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
Sophie A
http://orcid.org/0000-0001-8277-0524
SA
Pettit
Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
Len
L
Bowers
Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
Alex
A
Tulloch
Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
Alexis E
AE
Cullen
Molloy College, Rockville Centre, New York, USA.
Lois Biggin
LB
Moylan
South London and Maudsley NHS Foundation Trust, London, UK.
Faisil
F
Sethi
Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
Paul
P
McCrone
School of Healthcare, University of Leeds, London, UK.
John
J
Baker
Royal College of Psychiatrists, London, UK.
Alan
A
Quirk
Psychology, Social Work and Human Sciences, University of West London, London, UK.
Duncan
D
Stewart
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003068:Coercion; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006778:Hospitals, Psychiatric / Q000941:ethics / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics / Q000592:standards*; D008297:Male; D001523:Mental Disorders / Q000451:nursing*; D008605:Mental Health Services / Q000941:ethics / Q000592:standards*; D008875:Middle Aged; D010356:Patient Isolation / Q000941:ethics / Q000592:standards*; D017410:Practice Guidelines as Topic; D012149:Restraint, Physical / Q000941:ethics / Q000592:standards*; D012308:Risk Management / Q000379:methods
containment; manual restraint; mental health nursing; nursing; psychiatric care; seclusion