I sang Amazing Grace for about 3 hours that day : understanding Indigenous Australians’ experience of seclusion

Research shows that Indigenous Australians suspicion and fear of being ‘locked up’ may influence mental health service avoidance. Given this, the aim of this study was to explore, by qualitative analysis of in depth interviews (N = 3), how three Indigenous people experienced the controversial practice of seclusion Hans-Georg Gadamer’s phenomenology guided analysis of the material, and allowed narrated experiences to be understood within their cultural and historical context. Participants viewed seclusion negatively: police involvement in psychiatric care; perceptions of being punished and powerless; occasions of extreme use of force; and lack of care were prominent themes throughout the interviews. While power imbalances inherent in seclusion are problematic for all mental health clients, the distinguishing factor in the Indigenous clients’ experience is that seclusion is continuous with the discriminatory and degrading treatment by governments, police and health services that many Indigenous people have experienced since colonisation. The participants’ experiences echoed Goffman’s (1961) findings that institutional practices act to degrade and dehumanise clients whose resulting conformity eases the work of nursing staff. While some nurses perceive that seclusion reduces clients’ agitation (Meehan, Bergen & Fjeldsoe, 2004; Wynaden et al., 2001), one must ask at what cost to clients’ dignity, humanity and basic human rights.

Patients' perceptions of seclusion : a qualitative investigation

Twelve patients receiving acute in-patient psychiatric care in Queensland, Australia, participated in semi-structured interviews to elicit their perceptions of seclusion. All respondents had experienced time in seclusion within the 7 days prior to interview. Interviews were audiotaped, transcribed and analysed using content analysis. Five major themes emerged: use of seclusion, emotional impact, sensory deprivation, maintaining control and staff-patient interaction. The prevailing negativity towards seclusion underscores the need for ongoing critical review of its use. In particular, the relationship between patient responses to seclusion and the circumstances in which seclusion takes place requires greater consideration. Interventions such as providing information to patients about seclusion, increased interaction with patients during seclusion, attention to privacy and effective debriefing following seclusion may help to reduce the emotional impact of the practice.

Inpatients had mostly negative experiences of seclusion during short term treatment in a mental health facility

Design Semi-structured interviews. Setting 2 open, acute care units of a large tertiary mental health facility in Queensland, Australia. Patients 12 patients (58% men) who were 18–52 years of age and were secluded in the previous 7 days (mean duration 3.4 h). Methods Semi-structured, thematically organised interviews were audiotaped and transcribed. Transcripts were checked for errors against the audiotaped versions and were analysed using the process of meaning categorisation. Themes were identified and coded to produce categories. All members of the research team agreed on the final categorisations. These broad categories were further analysed, and themes were used to reflect patients' experiences of seclusion. Main findings 5 recurrent themes emerged. (1) Patients described the use of seclusion. Some patients thought that seclusion was used inappropriately and that the seclusion period was of more benefit to …

An investigation into the effectiveness of sensory modulation in reducing seclusion within an acute mental health unit

In this paper we report the findings from an evaluation of the introduction of sensory modulation (SM) in an acute mental health inpatient unit. It was expected that SM could be used to help settle patients experiencing high levels of disturbance and that as a result, there would be less need for use of more restrictive seclusion practices. The evaluation took place in a hospital in south-east Queensland, Australia. SM was introduced in one acute unit while the other served as a control. The evaluation comprised two studies. In the first study we aimed to determine whether SM reduced the level of disturbance among patients given the opportunity to use it. In the second study we aimed to find out whether the introduction of SM reduced the frequency and duration of seclusion. In study 1, we found that most patients reported marked reduction in disturbance after using SM and there was a very large effect size for the group as a whole. In study 2, we found that frequency of seclusion dropped dramatically in the unit that introduced SM but rose slightly in the unit that did not have access to SM. The change in seclusion rate was highly significant (χ2 = 49.1, df = 1, p < 0.001). Results are discussed, having reference to the limitations inherent in a naturalistic study.

Interventions for reducing the use of seclusion in psychiatric facilities : a review of the literature

Background The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

Aims To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

Method We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Results Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Conclusions Reducing seclusion rates is challenging andgenerally requires staff to implement several interventions.

Reducing seclusion in acute psychiatric inpatient settings : a need for strong leadership

Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for consumers of mental health services. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.

The aim is to review the research on seclusion-reduction initiatives in psychiatric facilities. We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and postseclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review. Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion. Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

Reducing seclusion in acute psychiatric inpatient settings : a need for strong leadership

Background: Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for psychiatric consumers. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.
Aims: To review the research on seclusion-reduction initiatives in psychiatric facilities.
Methods: We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and post-seclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review.
Results: Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion.
Conclusion: Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

Reducing seclusion in acute psychiatric inpatient settings : a need for strong leadership

Background: Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for psychiatric consumers. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.

Aims: To review the research on seclusion-reduction initiatives in psychiatric facilities.

Methods: We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and post-seclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review.

Results: Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion.

Conclusion: Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

The impact of the quality of behaviour support plans on the use of restraint and seclusion in disability services

Background: Behaviour support plan (BSP) quality is known to be an important aspect of the support provided to people with disability who show challenging behaviours and has been found to lead to reductions in challenging behaviour. Preliminary evidence suggests that quality of plans is associated with reductions in the use of restraint
and seclusion.
Method and materials: Quality of a sample of behaviour support plans was assessed using the Behaviour Support Plan – Quality Evaluation II (BSP-QE II) Guide (Browning Wright, Saren & Mayer, 2003). Episodes of restraint and seclusion before and during implementation of plans were examined by comparing restraint and seclusion use between individuals with high quality versus low quality plans.
Results: Compared to individuals with low quality plans, individuals with high quality plans were found to be subjected to less restraint and seclusion over time, while those with low quality plans were subjected to increases. With the exception of one quality component, all components in high quality plans were found to be associated with decreases in restraint and seclusion use.
Conclusions: The results support earlier preliminary findings that quality of behaviour support plans are associated with reductions in restrictive intervention use. The findings are important because they suggest that increasing quality of behaviour support plans may lead to decreases in restraint and seclusion over time.

Iniatives to reduce the use of seclusion and restraints on people with developmental disabilities: a systematic review and quantitative synthesis

Contrary to the expectations articulated in public policy, restrictive interventions are commonly used in support services for people with developmental disabilities. This systematic review and quantitative synthesis was undertaken to investigate whether the use of seclusion and restraints on people with developmental disabilities can be reduced. Searches of the Academic Search Complete, CINAHL, MEDLINE, and PsycINFO electronic databases returned 7226 records, of which 11 met the inclusion criteria for this review. A further 3 papers were obtained through scanning the reference lists of those articles included from the initial literature search. All 14 studies were single-subject designs focusing on initiatives to reduce physical or mechanical restraint. Between the baseline and intervention phases, there were mean reductions in the frequency and duration of restraint use of 79% (SD = 21%, n = 13 subjects from 7 studies) and 45% (SD = 58%, n = 10 subjects from 6 studies), respectively. For studies in which restraint use to manage agitation and aggression was targeted, there was a 79% (SD = 21%, n = 13 subjects from 7 studies) decrease in the frequency and a 28% (SD = 67%, n = 6 subjects from 3 studies) reduction in the duration of restraint. With respect to studies in which restraint use to prevent self-harm was targeted, there was a 71% (SD = 34%, n = 4 subjects from 3 studies) reduction in restraint use. Effect sizes were calculable, using non-overlap approaches, for 9 of the 14 studies. The magnitudes of the effect sizes suggest that, on average, the interventions were effective in reducing the use of restraints. The effects generated in studies where restraint use for self-harm was targeted were typically more pronounced than those in which restraint use for agitation and aggression was addressed. There were broad variations, however, in the percentage reductions in restraint use and in the magnitudes of the effect sizes. Although the findings of this review are encouraging, more research is needed, in which greater attention must be paid to rigorous research design, application, and analysis.

Individual and organisational factors associated with the use of seclusion in disability services

Background: Seclusion is a restrictive intervention that results in some form of containment and social isolation of a person from others. Little is known about the relationships between individual and organisation factors and the use of seclusion in disability services. Method: The reported use of seclusion in disability services in Victoria, Australia, was examined over a 3-year period, with a focus on the characteristics of those who were secluded (n = 146) and the characteristics of organisations that reported seclusion compared to others who were reported to be restrained but not secluded (n = 2,482). Results: Results from a logistic regression showed that the individual factors of age, the presence of autism and/or a psychiatric disorder put people at risk of being secluded. In terms of organisational factors, receiving accommodation services in institutions or in the community and the location of the organisation were risk factors. Conclusions: The findings are consistent with previous research but add to this literature by showing that certain organisational characteristics are also risk factors for seclusion. Understanding these factors is important in order to help disability support staff find other more ethical and appropriate alternatives to seclusion.