Re-Designing State Mental Health Policy to Prevent the Use of Seclusion and Restraint

  title={Re-Designing State Mental Health Policy to Prevent the Use of Seclusion and Restraint},
  author={Kevin Ann Huckshorn},
  journal={Administration and Policy in Mental Health and Mental Health Services Research},
  • K. Huckshorn
  • Published 1 July 2006
  • Medicine
  • Administration and Policy in Mental Health and Mental Health Services Research
 The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including “chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with… 
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.
Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital.
The data suggest that substantial reductions in use of seclusion and restraint are possible in inpatient psychiatric settings and that changes to the physical characteristics of the therapeutic environment may have a significant effect on use.
Restraint and seclusion in psychiatric treatment settings: regulation, case law, and risk management.
This article seeks to provide a foundation for evaluation of current protocols, an analysis of adverse R&S events, and strategies to minimize risk.
Is the seclusion policy of mental health care users a necessary evil
Younger male patients with psychosis were most likely to be secluded, and the most common diagnosis was schizophrenia, followed by cognitive impairment and bipolar mood disorder, and sodium valproate was the most commonly used medication.
Factors Associated with Seclusion Use in Forensic Mental Health Settings: An Integrative Review
Results indicate that common factors associated with the use of seclusion in forensic mental health settings are younger age, diagnosis of psychotic disorder or personality disorder, and previous seclusion, and sex differences are inconsistent.
Multinational experiences in reducing and preventing the use of restraint and seclusion.
Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology.
Reflection on the use of seclusion: in an acute mental health facility.
The study revealed a local facility seclusion rate of 12% compared with a national average of 10%, and consumers mostly perceived seclusion as punishing and nontherapeutic, in contrast to staff, who generally viewed it as appropriate and potentially therapeutic.
Feasibility of randomized controlled trials on seclusion and mechanical restraint
Ethical, methodological and legal problems of RCTs on coercive interventions and possible solutions are described and suggested to suggest possible solutions.
Seclusion reduction in a forensic mental health setting.
The initiatives that were introduced during a seclusion reduction project that was undertaken at an Australian forensic hospital based on the six core strategies that have been successfully used in North America to reduce seclusion are presented.


Seclusion and restraint for people with serious mental illnesses.
No controlled studies exist that evaluate the value of seclusion or restraint in those with serious mental illness and continuing use of se inclusion or restraint must therefore be questioned from within well-designed and reported randomised trials that are generalisable to routine practice.
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.
Nurses' judgments regarding seclusion and restraint of psychiatric patients: a social judgment analysis.
Clinical judgment of psychiatric nurses was investigated using judgment analysis within the framework of social judgment theory, and nurses generally favored close observation of patients over seclusion and restraint, and information about current behavior and functioning had more impact on nurses' judgments than did patient history.
Faulty assumptions associated with the use of restraints with children.
  • W. Mohr, J. Anderson
  • Psychology
    Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc
  • 2001
Alternatives to restraints must be investigated and developed to replace the current reactive, crisis-management orientation of practice and to discuss alternatives based on the developmental-ecological theoretical framework for responding to crises in children.
Trauma history screening in a community mental health center.
Screening for trauma history should be a routine part of mental health assessment and may significantly improve the recognition rate of PTSD, however, much work remains to be done in implementing appropriate treatment.
Posttraumatic stress disorder in the National Comorbidity Survey.
Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumAs.
Trauma and posttraumatic stress disorder in severe mental illness.
PTSD was predicted most strongly by the number of different types of trauma, followed by childhood sexual abuse, and is suggested to be a common comorbid disorder in severe mental illness that is frequently overlooked in mental health settings.
Crossing the Quality Chasm: A New Health System for the 21st Century
  • A. Baker
  • Medicine, Political Science
    BMJ : British Medical Journal
  • 2001
Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.