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Engaging doctors to reduce restraint
Published in Bernadette McSherry, Yvette Maker, Restrictive Practices in Health Care and Disability Settings, 2020
There has been a survey of Australian mental health professionals, in addition to consumers and carers, regarding their perspectives on seclusion and restraint (Kinner et al. 2016). A large majority of surveyed clinicians (including doctors) believed that seclusion and restraint practices were likely to cause harm, breach human rights, compromise trust and potentially cause or trigger past trauma (see McSherry in Chapter 11 in this volume for further details). Yet at the same time, the survey indicated that clinicians were very likely to consider restrictive practices to confer benefits of safety to consumers, staff and others, and set appropriate boundaries. It is reasonable to assume clinicians, and in this case doctors, have similar cognitive biases to the rest of the population and their behaviour is impacted by a complex range of influences.
Mental Health in the UK: the Legal Dimension
Published in David B Cooper, Developing Services in Mental Health–Substance Use, 2018
Consequently, the Code should be observed by all professionals who are using the Act and hospitals cannot depart from it as a matter of policy. Cogent reasons could relate to a hospital departing from the Code in respect of groups rather than individual patients. This could be a policy decision arising from the special problems of high security hospitals, which contain the most potentially dangerous patients in the country. It could justify differences in the seclusion policy with respect to the special position of such patients whom it was necessary to seclude for longer than a very few days.
Legal Aspects of Psychiatric Emergencies
Published in R. Thara, Lakshmi Vijayakumar, Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Parmanand Kulhara, Sandeep Grover
Seclusion is understood as involuntary confinement of a person alone in a room, which they are is physically prevented from leaving, or separating the patient from others and placing them in a safe, contained, controlled environment. Restraint is understood as the direct application of physical force to an individual, with or without their permission, to restrict their freedom of movement. Physical force may be applied through human touch, mechanical devices, or a combination of these. Some authors also include the use of drugs in the definition of restraint (Simon and Shuman 2007).
Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper
Published in Issues in Mental Health Nursing, 2023
Sara Brune, Laura Killam, Pilar Camargo-Plazas
Seclusion and restraint are common practices used in mental health settings to manage aggressive and violent patient behavior (Hendryx et al., 2010; Steinert et al., 2010). Seclusion involves isolating an aggressive or violent patient in a locked room until they are no longer deemed a safety risk (Mayers et al., 2010). Restraining violent patients means using devices such as limb binders, and restrictive vests that limit physical movements, and/or chemical restraints such as fast-acting antipsychotic medication (Fereidooni-Moghadam et al., 2014). Seclusion and restraint in mental health facilities has been shown to have detrimental physical and emotional consequences for both patients and nurses alike, in addition to eroding the nurse-patient relationship (Hendryx et al., 2010; Sequeira & Halstead, 2004).
An Integrative Review of Sensory Approaches in Adult Inpatient Mental Health: Implications for Occupational Therapy in Prison-Based Mental Health Services
Published in Occupational Therapy in Mental Health, 2021
Gisele Craswell, Crystal Dieleman, Parisa Ghanouni
As noted by Levenson and Willis (2019), the criminal justice system can lead to trauma reactions from its point of entry, with prevalent power disparities, exploitation of power, and use of coercive practices that can lead to re-traumatization. The risks from using seclusion and restraint are well documented and can include re-traumatization, occupational and sensory deprivation, the breaching of human rights, injury, and even death (Champagne, 2011; O’Sullivan & Fitzgibbon, 2018). Policies and practices need to be examined to prevent re-traumatization (Mental Health Commission, 2014; SAMHSA, 2014). This would include the reduction, if not elimination, of coercive practices, such as seclusion and restraint (O’Hagan et al., 2008; World Health Organization, 2017), as well as the introduction of person-centred, recovery-oriented and trauma-informed interventions; such as the sensory modulation approach (Chandler, 2008; LeBel & Champagne, 2010; LeBel et al., 2010). A shift from a medical model of mental health care to a trauma-informed care model is needed within the criminal justice system, which will be challenging given that it would require a paradigm shift from control to collaboration (Chandler, 2008).
A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit
Published in Issues in Mental Health Nursing, 2021
Judy Haefner, Ifeoma Dunn, Marilyn McFarland
One of the interventions often used with agitated patients is seclusion (Knox & Holloman, 2012). Seclusion is viewed as a type of restraint which involves confining a patient to a locked room or an area restricting or forbidding free movements (Knox & Holloman, 2012). Seclusion, as an intervention to manage acutely disruptive and violent behaviors among patients in the psychiatric context, is a highly contentious issue. It is perceived by some as an infringement of basic human rights and dignity, while others believe it is an unavoidable intervention to maintain safety and control. Despite guidelines for promoting alternative interventions, data from the U. S. and Europe show that 10 to 30 percent of adolescents, adults, and older adult patients in psychiatric units still receive seclusion as the primary intervention for agitated behavior (Agency of Healthcare Research and Quality [AHRQ], 2015).