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

Reducing seclusion on mental-health wards

People with severe mental-health problems are sometimes locked in a room on their own for the protection of themselves and other people. This practice is known as seclusion and is very controversial with critics seeing it as degrading and traumatising. There is also the risk that patients might get hurt as they struggle to avoid being placed in the rooms and may come to harm as they are left in isolation; and there are also worries that seclusion can damage people's mental health. In the U.S. a treatment known as sensory modulation is used to reduce the incidence of people being placed in seclusion; this can include weighted blankets, multisensory treatment rooms - which might contain paintings, music and reading material - portable music players and optical lamps. At the same time clinicians often try to assess which things might trigger people to become severely agitated and what the patients themselves feel would be the best things to calm them down. A team of researchers from the Alfred Hospital and Monash University - both in Melbourne - studied the use of sensory modulation and an assessment scheme called Safety Tool in a 30-bed psychiatric intensive-care unit. Before the use of these techniques 65% of the patients had previously been secluded but after their introduction only 26% were. 76% of the staff on the unit thought that Safety Tool should be part of standard care.

Lee, Stuart J. ... [et al] - Sensory assessment and therapy to help reduce seclusion use with service users needing psychiatric intensive care Journal of Psychiatric Intensive Care 6(2) 83-90

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