Nursing Online – September 2008

Brave new world of mental health

In the past decade there has been a significant growth in the literature and evidence based practice development, which suggests mental health services can be delivered safely without reliance on seclusion and restraint. The evolution in mental health service delivery is being supported in Australia with the establishment of the National Mental Health Seclusion and Restraint Project, which aims to reduce and, where possible, eliminate the use of seclusion and restraint in public mental health services. This month Nursing Online highlights some of these initiatives.

Trieste Mental Health Department

The Trieste Mental Health Department is a public, community-based mental healthcare service that evolved directly from the pioneering de-institutionalisation experiences of Franco Basaglia and his collaborators in the 1970s. Recognised for years as one of the most advanced public mental healthcare services in the world, the Trieste MHD continues to remain a leader in innovative approaches to mental healthcare aimed at the emancipation and social reintegration of persons suffering from mental disorders.
www.triestesalutementale.it/english/index.htm

A British Perspective on the Use of Restraint and Seclusion in Correctional Mental Health Care
John C. O’Grady, MB, ChB, FRC Psych

Policy and practice in the safe management of disturbed and violent behaviour as applied in USA and UK correctional facilities is examined in this article. Certain differences emerge and are discussed, particularly relating to physical restraint. The paucity of evidence to support particular interventions is highlighted through a review of a UK systematic analysis of world literature on best practice.
J Am. Acad. Psychiatry Law 35:439–43, 2007
http://jaapl.org/cgi/reprint/35/4/439

Pennsylvania State Hospital System’s Seclusion and Restraint Reduction Program
Gregory M. Smith, M.S.; Robert H. Davis, M.D.; Edward O. Bixler, Ph.D.; Hung-Mo Lin, Ph.D.; Aidan Altenor, Ph.D.; Roberta J. Altenor, M.S.N.; Bonnie D. Hardentstine, B.S.; George A. Kopchick

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. 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 hospitals: one identified date, time, duration, and justification for each episode of seclusion or restraint and the other identified when a patient was hospitalised and the demographic characteristics and the diagnosis of the patient. Rate and duration of seclusion and restraint were calculated. Reports from compensation claims were used to determine staff injuries from patient assaults. The study found that the rate and duration of seclusion and mechanical restraint decreased dramatically during this period.
Psychiatric Services 56:1115–1122, 2005
http://psychservices.psychiatryonline.org/cgi/reprint/56/9/1115.pdf

Seclusion Practice: A literature review
Dr Angela Livingstone

The Victorian Quality Council (VQC) and Chief Psychiatrist’s Quality Assurance Committee (QAC) have formed a partnership to support the development and implementation of the Creating Safety: Addressing Seclusion Practices project to enable clinicians to apply best available evidence to clinical practice.

The project aims to strengthen and support safety in adult acute mental health inpatient units and to minimise, wherever possible, the frequency and duration of the use of seclusion. This literature review was prepared to support the project.
www.health.vic.gov.au/creatingsafety/litreview.pdf