Interventions for reducing the use of seclusion in psychiatric facilities. Review of the literature

Abstract

Background: The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted. Aims: To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities. Method: We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion. Results: Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare. Conclusions: Reducing seclusion rates is challenging and generally requires staff to implement several interventions.