Elements of Successful Restraint and Seclusion Reduction Programs and Their Application in a Large, Urban, State Psychiatric Hospital

  title={Elements of Successful Restraint and Seclusion Reduction Programs and Their Application in a Large, Urban, State Psychiatric Hospital},
  author={William A. Fisher},
  journal={Journal of Psychiatric Practice},
  • W. Fisher
  • Published 1 January 2003
  • Psychology
  • Journal of Psychiatric Practice
In recent years, there has been a strong desire on the part of inpatient psychiatric programs to reduce the use of seclusion and mechanical restraint. There is a consensus among those who have published descriptions of successfully implemented restraint and seclusion reduction programs that the essential elements of such programs are high level administrative endorsement, participation by recipients of mental health services, culture change, training, data analysis, and individualized treatment… 

Reduction of episodes of seclusion and restraint in a psychiatric emergency service.

The authors developed a comprehensive plan focusing on the early identification and management of problematic behaviors in an effort to reduce seclusion and restraint in a psychiatric emergency

Decreasing the Use of Restraint and Seclusion Among Psychiatric Inpatients

Interventions were successful in decreasing use of restraint and seclusion on both clinical and research units over more than 5 years of follow-up, and may be adapted to other settings.

A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

This review examines the nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients and concludes that more attention should be paid to understanding how interventions work, particularly from the perspective of nursing staff.

The New York State Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project.

All three participating mental health treatment facilities continued to implement key components of the PARS initiative after termination of grant-funded activities, and OMH initiated multiple activities to disseminate lessons learned during the project to all inpatient and residential treatment programs throughout the state mental health system.

Evidence base for practice: reduction of restraint and seclusion use during child and adolescent psychiatric inpatient treatment.

  • K. Delaney
  • Psychology
    Worldviews on evidence-based nursing
  • 2006
It is suggested that sites pool data on restraint use and reduction efforts to create a database for benchmarking and studying variations among hospitals, and attention should also be given to developing additional means for addressing aggressive behaviors.

Violence and Restraint Reduction Efforts on Inpatient Psychiatric Units

  • M. Johnson
  • Psychology
    Issues in mental health nursing
  • 2010
An integrative review of research and quality improvement projects that aimed to reduce aggression/violence or restraint/seclusion through the use of an educational program is presented.

Reducing seclusion and restraint: questionnaire for organizational assessment.

The development of an instrument that measures staff perceptions of organizational activities to reduce seclusion and restraint as well as staff attitudes toward the use of these interventions is described.

Interventions for reducing the use of seclusion in psychiatric facilities

Reducing seclusion rates is challenging and generally requires staff to implement several interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement and more.

Eliminating seclusion and restraint in recovery-oriented crisis services.

The success of this initiative suggests that policy makers and organizational leaders familiarize themselves with these and other similar seclusion and restraint reduction strategies that now exist.

Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia.

Seclusion and restraint were prevented without an increase of violence in wards for men with schizophrenia and violent behavior and a similar reduction may also be feasible under less extreme circumstances.



Reducing seclusion and restraint: meeting the organizational challenge.

The Mohawk Valley Psychiatric Center has experienced a major reduction in the use of seclusion and restraint in the past five years. It has used the traditional quality improvement (QI) tools like

Characteristics of patients in restraint: six year analysis of the Assaulted Staff Action Program (ASAP).

This study compared restrained and non-restrained subjects on basic demographic variables and the clinical variables of histories of violence toward others, personal victimization and substance use disorder and found that clinical variables did not enhance the prediction of the use of restraints.

Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients.

The number of episodes of seclusion and restraint fell by 64 percent after the protocol was adopted, and the number of patients who required those interventions dropped by 39 percent.

Reducing the use of full-leather restraints on an acute adult inpatient ward.

The authors describe a program to reduce the use of full-leather restraints on an acute adult inpatient psychiatric ward of a large community mental health center. It included the introduction of a

A study of patients' attitudes toward placement in seclusion.

This study conducted over a eight-month period on the locked crisis intervention unit of the Langley Porter Psychiatric Institute in San Francisco provides short-term therapy and serves as a community mental health facility for the local area.

Least restrictive measures: alternatives to four-point restraints and seclusion.

  • E. MoralesP. Duphorne
  • Psychology, Medicine
    Journal of psychosocial nursing and mental health services
  • 1995
When staff became more knowledgeable about the use of alternatives, they were more comfortable offering patients choices and did not wait until restraints and seclusion were necessary, and it was beneficial to review the rationale for theUse of seclusion and restraints with both patients and staff.

Reducing the use of restrictive procedures in a residential facility.

It is concluded that instructions and feedback are an effective and inexpensive way to reduce the use of restrictive treatment procedures and that the approach used in their facility merits further investigation.

Restraint and seclusion: a review of the literature.

  • W. Fisher
  • Medicine
    The American journal of psychiatry
  • 1994
The literature on restraint and seclusion supports the following: 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation, and 2) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects.

Reducing restraint use in a nursing home.

  • J. Kramer
  • Medicine
    Clinical nurse specialist CNS
  • 1994
CNSs are uniquely qualified to move a facility toward the goal of reducing the use of restraints, and their skills as leaders, educators, change agents, consultants, and systems experts are most essential.

Restraint, seclusion, and clozapine.

For patients who were restrained or secluded before clozapine treatment, the decrease in the number and duration of restraint and seclusion episodes was dramatic.