Deaf people, seclusion and restraint

It is widely believed that people who are deaf or who have hearing problems are more often subject to restraint and seclusion in mental-health services than other people but there is little hard evidence to back this up. Researchers from Oregon State Hospital and Pacific University in Oregon compared 22 deaf or hard of hearing people committed to a large state hospital with 22 similar people who had also been committed but who did not have hearing problems. They found that the people with hearing problems were more likely to be subject to seclusion and restraint although the people with good hearing were, on average, secluded for longer.

Hartman, Brian and Blalock, Ann - Comparison of Seclusion and Restraint Prevalence between Hearing Patients and Deaf or Hard of Hearing Patients in a State Hospital Setting Issues in Mental Health Nursing, 32: 42–45, 2011

Seclusion and restraint in Canada

Patients in psychiatric hospitals are often put on their own - in seclusion - for a while until they calm down and stop being a danger to either themselves or others. However, researchers don't know that much about how often it happens or which people are most likely to be placed in seclusion. Researchers from Montreal University studied 2,721 psychiatric patients. They found that 23.2% of them had been placed in seclusion and that 17.5% of them had been secluded with (physical) restraint. Being young; suffering from schizophrenia or psychosis; suffering from bipolar or personality disorder and having to stay in hospital for a longer time were all associated with seclusion while being young, having bipolar or personality disorder and staying for a longer time in hospital were all associated with having to be physically restrained.

Dumais, A. ... [et al] - Prevalence and correlates of seclusion with or without restraint in a Canadian psychiatric hospital: a 2-year retrospective audit Journal of Psychiatric and Mental Health Nursing doi: 10.1111/j.1365-2850.2010.01679.x

Physical restraint in psychiatric hospitals

There is a high level of violence on psychiatric-hospital wards. It has been estimated that almost half of nursing staff and one in seven patients are subject to physical assaults per year. Physical restraint is recommended only as a method of last resort for dealing with violence but relatively little is known about how often it is used and the circumstances of its use. Researchers from City University in London reviewed 45 studies into physical restraint. They found that, on average, five episodes of manual restraint a month might be expected on a typical 20-bed ward. Episodes lasted around ten minutes with about half involving the restraint of patients on the floor, usually in the prone position. Manually-restrained patients tended to be younger, male and detained under mental-health legislation.

Stewart, D. ... [et al] - Manual restraint of adult psychiatric inpatients: a literature review Journal of Psychiatric and Mental Health Nursing October 2009, 16(8), 749-757

Reducing restraint in New York

Restraint and seclusion are 'last-resort' tactics that are used when a psychiatric patient presents an imminent risk to either themselves or others. They can cause emotional trauma, physical harm to patients or staff and even death as well as exposing hospitals to litigation and criminal prosecution. Researchers in New York looked at three different interventions aimed at reducing the use of restraint and seclusion. These were : decreasing the initial amount of time patients spent in restraint or seclusion, education of staff concerning identification of patients at risk of restraint or seclusion and early interventions to avoid crises and the use of coping questionnaires to assess patient preferences for dealing with agitation. After more than five years of the new policies the number of patients restrained was reduced, the hours of restraint fell, the number of patients secluded 'decreased significantly' and the mean hours of seclusion 'decreased markedly'. There were also significant decreases in patients absconding, fights and assaults.

Hellerstein, David J. – Decreasing the use of restraint and seclusion among psychiatric inpatients Journal of Psychiatric Practice September 2007, 13(5), 308-317