RESEARCH WEEKLY: Ending Seclusion and Restraint in State Hospitals By Elizabeth Sinclair Hancq (February 8, 2023) Seclusion and restraint are invasive practices used in clinical settings to control and de-escalate patients experiencing extreme agitated behaviors. Once used routinely in inpatient psychiatric settings, clinical care guidelines now state these practices should only be used in emergencies as a last resort for safety and should not be considered a treatment intervention. Since 1990, the Pennsylvania Department of Human Services’ Office of Mental Health and Substance Abuse Services has been monitoring the effects of reducing seclusion and restraint in their state hospital system. Research published this month in Psychiatric Services by study authors from OMHSAS suggests that over the past 30 years, the state hospital system has successfully ended seclusion and restraint without jeopardizing safety of the patients or staff. What is seclusion and restraint, and why is it used? Seclusion is the involuntary placement of a patient in a bare room who is not allowed to leave. Physical restraint is the utilization of material or device that immobilizes a patient’s arms, legs, head or body from moving freely. Chemical restraint is when a drug is used to restrict and manage a patient’s behavior that is outside the standard treatment or dosage for that individual. Seclusion and restraint interventions have been used to control agitated patients who are believed to be at risk of harming themselves, the staff or others around them. Historically, these practices were often used on individuals with severe mental illness in inpatient psychiatric settings to help control their erratic and potentially dangerous behavior. However, research has shown that seclusion and restraint practices are in fact harmful and dangerous themselves, resulting in increased risk of injury to patients and staff, as well as having significant negative psychological effects on the patient who is subjected to them. Ending seclusion and restraint in Pennsylvania state hospitals The Pennsylvania state hospital system utilized multiple strategies for reducing seclusion and physical restraint in both their civil and forensic hospital systems, emphasizing staff training, de-escalation techniques and a person-centered approach to care. To analyze the impact of these efforts, the study authors examined data on seclusion and restraint usage from 2011 – 2020 in six civil and two forensic state hospitals, representing 4.8 million days of care over the study period. The authors found that the frequency and duration of seclusion and restraint significantly declined over the 10-year study period. In the civil hospitals, mechanical restraint was last used in September 2015, and seclusion was last used in July 2013. Seclusion and restraint use also declined in the forensic hospital system, last being used in 2014. In the instances where restraints were used, women were more likely to experience physical restraint, especially Black women. People with co-occurring diagnoses of a serious mental illness and an intellectual disability disorder also experienced a larger share of the restraint episodes. In both the civil hospitals and forensic centers, reduced seclusion and restraint usage was associated with reductions in injuries to patients and staff. “Results from this ongoing study reveal that reduced use of containment procedures leads to a safer and healthier environment of care and treatment for patients and staff without further traumatizing patients or their caregivers,” the authors wrote. Conclusion The results from this study strongly suggest that seclusion and restraint usage can be significantly reduced in both civil and forensic state hospital systems. The Pennsylvania state hospital system’s dedication to staff training on de-escalation and use of a person-centered approach to care were successful in supporting this change in clinical practices. However, more work is still needed to address the racial and gender disparities on restraint usage in these settings. References Smith, G.M., et al. (2022, February). Effects of ending the use of seclusion and mechanical restraint in the Pennsylvania state hospital system, 2011-2020. Psychiatric Services. Elizabeth Sinclair Hancq is the director of research at Treatment Advocacy Center. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. Questions? Contact us at [email protected] Research Weekly is a summary published as a public service of Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications. Treatment Advocacy Center does not solicit or accept funds from pharmaceutical companies. Treatment Advocacy Center | 200 N Glebe Rd, Ste 801, Arlington, VA 22203 Unsubscribe [email protected] Update Profile | Constant Contact Data Notice Sent by [email protected] powered by Try email marketing for free today!