Monday, November 16, 2009

Seclusion and restraint in psychiatric intensive care units

Patients in psychiatric intensive care units (PICUs) often have to be placed in seclusion or restraint for their own or others' protection. U.K. researchers from NHS services in Suffolk, Hampshire and Oxford studied the patterns of seclusion and restraint in 332 patients admitted to 7 PICUs in England. They found that four of the units used seclusion on a total of 16% of their patients. All of the units used restraint on 28% of the admitted patients. Using seclusion did not affect the length of time patients were being restrained for or how many patients were restrained. The use of seclusion and restraint was significantly associated with patient violence and property damage. Restraint was also associated with higher levels of psychological disturbance and a younger patient age.

Dye, Stephen, Brown, Steve and Chhina, Navjyoat - Seclusion and restraint usage in seven English psychiatric intensive care units (PICUs) Journal of Psychiatric Intensive Care December 2009, 5(2), 69-79


Pamela Wagner said...

Regarding the use of Seclusion and Restraints...I was horrified to learn that in UK tPICUs these practices are still so rampant.. In the US I am glad to say they are beginning to learn that violence against patients only begets more violence, which is usually directed against the hospital staff, who after all have perpetrated it against the patients.

However, despite progress against these barbaric procedures, just this past October I was subjected to them once again, several times, so I was told (not remembering much, due to severe memory loss). I do nonetheless remember some of it, and it was so traumatic that I am having trouble recovering from it, even though I have been subjected to them in the past many times over. (for an account of it see my blog

I cannot emphasize enough that there is another and a better way. I'd thought, but was apparently mistaken, that you Brits had long ago discovered it: kindness, patience and understanding. But esp. patient listening, combined with a firm determination NOT to resort to violence against a suffering, ill human being goes a very long way in preventing further violence, both in the treating staff and in an already troubled and potentially agressive patient.

Let me add that in terms of a self-injurious person, it makes little sense to subject such a person to the brutality of restraints, as it is ALWAYS seen as what it is: punishment and the kind of injury the person already feels he or she deserves. How can they begin to feel deserving of kind treatment from themselves when the staff treats them with such abject cruelty...?

Pam W.

John Gale (Mental Health Update) said...

Thanks for your post Pamela. I guess we would all agree that it is definitely best to keep seclusion and physical restraint to a minimum. Unfortunately I do think there are certain circumstances in which service users do pose a risk either to themselves or others. I am not sure what the answer to this is but it is certainly a very difficult issue.
Best Wishes,
John Gale,
Mental Health Update

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