A comparison of the use of seclusion and mechanical restraints in psychiatric inpatient settings

Abstract

Physical restraints and seclusion are coercive interventions which are used to manage violent behavior of patients who are receiving treatment in psychiatric hospitals (Georgieva, Mulder & Whittington, 2012). The purpose for the use of restraints and seclusion is mainly to protect the patients themselves from any harm and people working around them, however they are highly controversial due to the fact that they restrict the patient’s freedom of movement and are used against the patient’s will (Georgieva et al. 2012). Despite this controversy, these methods continue to be used extensively in many countries (Iversen, 2009). The aim of this critical appraisal was to compare the effectiveness of the two coercive measures when used on psychiatric patients. For this reason, the following question was set: In psychiatric patients, does the use of seclusion, compared to mechanical restraints, result in less subjective distress? Psychiatric patients were the population of interest whilst seclusion was the choice for the main intervention. The comparison intervention was mechanical restraint, while a reduction in subjective distress was the expected outcome. The search for literature was carried out using reputable databases available in the University of Malta library online resources such as CINAHL, Academic Search Complete and PubMed. Google Scholar was also used. Different keywords associated with the PICO framework were used to identify new studies. The studies chosen were assessed against inclusion and exclusion criteria, such as the language and research design. Eleven full-text studies published in English between 1999 and 2012 were identified and appraised using a number of critical appraisal tools, mainly CASP (CASP Team, 1993). The findings clearly indicate that there are great similarities with regards to the effects and the use of physical restraints and seclusion. However, although no direct answer to the PICO question was found, both measures were linked to significant subjective distress. The conclusions of the majority of the authors were similar, in which they stated that it would be more beneficial to use alternative techniques such as de-escalation techniques, close engagement and building of a therapeutic relationship rather than seclusion and restraints. This appraisal indicated several recommendations with regards to research, education, practice, policy changes and management. The education of staff members was highlighted as the most important recommendation. Strategies to implement these recommendations followed.