In hospital settings, and especially in forensic psychiatric ones, restlessness, aggression, and even violence are familiar issues to healthcare workers. Under these circumstances, the need for restrictive measures (seclusion, mechanical/chemical restraints) is sometimes needed. Although such measures should be considered as exceptional interventions, they continue to be widespread in general, ...

OBJECTIVE To evaluate the use in a psychiatric intensive care unit of a newly introduced seclusion room for the management of acutely disturbed and/or violent patients. METHOD A specially designed seclusion chart was used to document fully events immediately before, during, and immediately after seclusion. Data from the charts over a 6-month period provided the basis for the study. RESULTS ...

Historical and current experience indicates that regulatory changes in seclusion and restraint practice are often spurred by patient abuse but can ultimately enhance protection for consumers, prevent use of seclusion and restraint, and help transform care so it becomes recovery oriented. Reports of deaths related to restraint and seclusion fueled recent national regulatory changes and a federal...

Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychi...

Since the late 1990s, scores of American cities have witnessed the re-emergence of large-scale homeless encampments for the first time since the Great Depression. Commonly portrayed as rooted in the national economic downturn and functionally undifferentiated, this paper demonstrates that large-scale encampments are rather shaped by urban policies and serve varied and even contradictory roles i...

Methods In an ongoing multi-center study conducted in three acute emergency psychiatry institutions, we retrospectively examine data from seclusion and restraint protocols and data about all the patients admitted over a two-year period. We note how many patients have had episodes with seclusion and restraint. We also note duration/time/ date of each episode and the reason given for using seclus...

OBJECTIVES This study examined the use of seclusion and mechanical restraint from 1990 to 2000 and the rate of staff injuries from patient assaults from 1998 to 2000 in a state hospital system. METHODS Records of patients older than 18 years who were civilly committed to one of the nine state hospitals in Pennsylvania were included in the analyses. Two databases were used in each of the nine ...

The use of seclusion and physical restraint is viewed as a practice incompatible with the vision of recovery, and its therapeutic benefit remains unsubstantiated. This Open Forum describes an initiative that began in 1999 at two crisis centers that was designed to completely eliminate the practice of seclusion and restraint. Seclusion and restraint elimination strategies included strong leaders...

BACKGROUND Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. AIMS To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. METHOD A cluster randomised controlled trial was co...

The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as other countries in and outside Europe. The aim of this study is to describe Dutch seclusion data and compare these with data on other countries, derived from the literature. An extensive search revealed only 11 articles containing seclusion rates of regions or whole countries either in Europe, Aust...