Regulatory, clinical, and educational approaches to eliminating restraint and seclusion

Lebel, Janice
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Conference Paper
Background In response to national media attention on restraint and seclusion (R/S), state and national efforts in the USA have organized around the goal of eliminating their use. Several states/organizations have significantly reduced and stopped using these violent procedures. Participants will learn: 1) How some states/organizations changed treatment practice to prevent inpatient violence, 2) Why an understanding of trauma and factors contributing to treatment violence are essential, 3)Why the consumer and family voice is of key importance, 4) What state and national data indicates about the success of these efforts. Methods Massachusetts implemented a R/S prevention initiative after a process of data, literature, and better practice reviews. Leadership prioritized the effort and promoted education for staff. Ongoing training, strategic planning, and teaching helped to shift the ownership of the effort. Inpatient providers became equally responsible for the outcome. Effective culture change constructs/strategies were identified, helped to inform a federal initiative (SAMHSA/NASMHPD-NTAC), and were included in an emerging evidence-based curriculum of "Core Strategies" to prevent and reduce treatment violence and coercion. Results Massachusetts' child/adolescent hospitals decreased their use of mechanical restraint by 85% and medication restraint by 88%. Some programs stopped using R/S altogether. These changes induced hope and reduced costs. Conclusion The use of R/S can be prevented and reduced to a level where it occurs rarely. Effective strategies have been identified and are being implemented. Courageous, focused leadership, at all levels of each organization involved in this type of process, is key to the success of this culture change effort.


Related Articles

  • Epidemiology of inpatient violence and coercive measures. Steinert, Tilman // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Objective To give an overview of the current knowledge on the epidemiology of in-patient violence and coercive measures in clinical psychiatry. Methods Many studies have been conducted on the epidemiology of in-patient violence by use of standardized scales such as the SOAS-R. Much research on...

  • Magnetic attractions. Gray, Jean // Nursing Standard;2/18/2004, Vol. 18 Issue 23, p3 

    Introduces a series of articles which appeared in the issue of February 18, 2004 issue of the "Nursing Standard". Nursing moral and job satisfaction in Great Britain; Institutional racism in the mental health services and the use of restraint methods for the management of violence.

  • We must play our part in improving care.  // Nursing Standard;2/18/2004, Vol. 18 Issue 23, p9 

    Focuses on the findings of an independent inquiry into David Bennett's death in a mental health facility in Great Britain. Need to strengthen mental health services for black and minority ethnic people; Need to develop guidance on appropriate ways for managing aggression and violence in mental...

  • Trust changes its working practices.  // Nursing Standard;2/18/2004, Vol. 18 Issue 23, p9 

    Reports that the Norfolk Mental Health Care National Health Service Trust has apologized to the family of David Bennett, who died from the mental health clinic in England. Claim of the director of nursing and education Linda Phillips that they have completed a training on the prevention and...

  • Crash teams feel 'sexual high' in restraint incidents.  // Mental Health Practice;Mar2004, Vol. 7 Issue 6, p5 

    Reports that mental health care professionals need to temper their use of control and restraint in dealing with violent psychiatric patients. Views of London, England-based psychiatric nursing educator Premila Trivedi; Risk of committing abuse.

  • Staff attitudes and thoughts about the use of coercion in acute psychiatric wards. Husum, Tonje; Bjørngaard, Johan; Finset, Arnstein; Ruud, Torleif // Social Psychiatry & Psychiatric Epidemiology;Sep2011, Vol. 46 Issue 9, p893 

    Purpose: Previous research has shown considerable differences in how often coercive measures are used in mental health care between groups of patients, institutions and geographical areas. Staff attitudes towards the use of coercion have been put forward as a factor that may influence these...

  • Use of coercive measures in a psychiatric sub-acute unit. 6-month review. Moreiras, N.; Roda, S.; Ribas, Joan S.; Vicens, E.; Torres, M.; Moyano, R.; Artero, Carmen M. // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background In our psychiatric hospital we have a guideline in order to regulate the use of coercitive measures (isolation in specials rooms and use of safety straps). These measures are the last kind of intervention we use. The guideline defines us the procedure for using the different measures,...

  • Definition and use of coercive measures in old age psychiatry settings in Germany and Wales. Kronstorfer, Rita // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background Patients with organic mental disorders (ICD 10 F0) are a high risk group in regard to being subject to coercive measures. Methods used in old age psychiatry tend to vary widely among European countries. Legal background, ethical considerations, staffing levels and techniques available...

  • A comparison between seven Swiss and seven German hospitals concerning the use of coercive measures. Bernhardsgrütter, Renate // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background In 2004, two independent working groups in Germany and Switzerland compared the frequency and duration of coercive measures in standard psychiatric care across 14 psychiatric hospitals in Germany and Switzerland. The objective was to establish an international knowledge transfer...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics