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...

  • 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...

  • Legislation and practice of coercive measures during in-patient treatment in 12 European countries: results of a case vignette study. Steinert, Tilman; Lepping, Peter; Needham, Ian // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background Patients who exhibit violent behavior or refuse medication during in-patient treatment are a challenge for clinical management. The management of those clinical situations is different in European countries with respect to legislation and clinical routine. Methods We selected three...

  • Inpatient and emergency child and adolescent psychiatry units in Sweden do not use restraint and seclusion: what we have learned. Rydelius, Per-Anders // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    The Swedish Health and Medical Services Act states that health and medical care for all children, youth and adults shall: Be of a high standard and satisfy the patients need for security; Be easily accessible; Be based on respect for the patients right to self-determination and integrity;...

  • 1-year follow-up of a randomized controlled trial comparing seclusion and mechanical restraint in people with serious mental illness. Bergk, Jan; Birk, Michael; Steinert, Tilman // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background Seclusion and mechanical restraint are widely used for people with serious mental disorders. In most countries one intervention is preferred while the other is considered as inhuman or not sufficiently safe, but identical arguments refer to different preferences. There is a lack of...

  • Staff members' attitudes towards coercive measures. Bergk, Jan; Steinert, Tilman // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background Coercive measures are associated with high strain for staff members. Most commonly used are mechanical restraint and seclusion. Both interventions are relatively secure and are considered as helpful in prevention of serious harm to self or others when other means are ineffective....

  • Provider groups unite on seclusion and restraint document.  // Getting Paid in Behavioral Healthcare;Mar2003, Vol. 8 Issue 3, p5 

    Reports on the publication of 'Learning From Each Other: Success Stories and Ideas for Reducing Restraint/Seclusion in Behavioral Health,' by a collaboration of national health associations. Offer of strategies that direct-care providers and administrators can consider as they update policies...

  • The Use of Seclusion and Restraint in Psychiatry. Chaimowitz, Gary // Canadian Journal of Psychiatry;Aug2011, Vol. 56 Issue 8, p1 

    The article offers information on the use of restraint and seclusion in psychiatry in Canada. It mentions that restraint and seclusion are only used in acute psychiatric patients to protect themselves and to avoid risks. It notes that seclusion and restraint should only be used during emergency...

  • Organizational and Unit Factors Contributing to Reduction in the Use of Seclusion and Restraint Procedures on an Acute Psychiatric Inpatient Unit. Pollard, Richard; Yanasak, Elisia V.; Rogers, Steven A.; Tapp, André // Psychiatric Quarterly;Spring2007, Vol. 78 Issue 1, p73 

    The use of seclusion or restraint (S/R) as an emergency medical intervention to assist patients in regaining behavioral control continues to be an area of interest and concern for the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), consistent with the ongoing concerns...


Read the Article


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

Try another library?
Sign out of this library

Other Topics