Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-05T04:56:03.574Z Has data issue: false hasContentIssue false

Reduction in the use of seclusion in a high secure hospital: A retrospective analysis

Published online by Cambridge University Press:  18 November 2009

Inti Qurashi*
Affiliation:
Consultant Forensic Psychiatrist, Ashworth Hospital, Liverpool, UK
Des Johnson
Affiliation:
Deputy Service Manager, Ashworth Hospital, Liverpool, UK
Jenny Shaw
Affiliation:
Consultant Forensic Psychiatrist, Guild Lodge Regional Secure Unit, Preston, UK
Ben Johnson
Affiliation:
Consultant Psychiatrist, Ashworth Hospital, Liverpool, UK
*
Correspondence to: Dr Inti Qurashi, Ashworth Hospital, Parkbourn, Maghull, Liverpool, United Kingdom, L31 1HW. E-mail: [email protected]
Get access

Abstract

Specific concerns have been raised about seclusion use within mental health services. However, it has been reported that one of the potential consequences of reduced seclusion use is an increase in assaults on either clinical staff or patients. In a high secure hospital a number of measures were implemented as part of a clinical governance programme. These measures will be described. Data on all episodes of seclusion and adverse incidents over a five year period was analysed. The results demonstrate a progressive and sustained reduction in seclusion use with over a sixty percent reduction in the number of seclusion episodes. We found no increase in adverse incidents in conjunction with the reduction in seclusion use. The results of this analysis demonstrate that reductions in seclusion use are achievable, without an increase in assaults on clinical staff or patients, when it is identified as both a managerial and clinical priority, supplemented by robust performance monitoring and effective clinical governance arrangements.

Type
Original Paper
Copyright
Copyright © NAPICU 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, N.C., Menditto, A.A., Baldwin, L., et al. (1991) Reduced frequency of aggressive behavior in forensic patients in a social learning program. Hospital and Community Psychiatry. 42: 750752.Google Scholar
Betemps, E.J., Somoza, E. and Buncher, C.R. (1993) Hospital characteristics, diagnoses, and staff reasons associated with use of seclusion and restraint. Hospital and Community Psychiatry. 44: 367371.Google ScholarPubMed
Chengappa, K.N.R., Vasile, J., Levine, J., Ulrich, R., Baker, A., Gopalani, A. and Schooler, N. (2002) Clozapine: Its impact on aggressive behavior in a state psychiatric hospital. Schizophrenia Research. 53(1–2): 16.CrossRefGoogle Scholar
Currier, G.W. and Farley-Toombs, C. (2002) Use of restraint before and after implementation of the new HCFA rules. Psychiatric Services. 53(2): 138.CrossRefGoogle ScholarPubMed
Department of Health (2007) Policy Framework for the Reporting and Briefing of Incidents and Issues in High Security Hospitals. London: DHGoogle Scholar
Department of Health (2008) Mental Health Act 1983 Code of Practice 2008 Revision. London: The Stationery Office.Google Scholar
Donat, D.C. (2003) An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatric Services. 54: 11191123.CrossRefGoogle Scholar
D'Orio, B.M., Purselle, D., Stevens, D. and Garlow, S. (2004) Reduction of episodes of seclusion and restraint in a psychiatric emergency service. Psychiatric Services. 55: 581583.CrossRefGoogle Scholar
Harty, M., Shaw, J., Thomas, S., et al. (2004) The security, clinical and social needs of patients in high-security psychiatric hospitals in England. Journal of Forensic Psychiatry and Psychology. 15: 208221.CrossRefGoogle Scholar
House of Lords (2005) R. v. Ashworth Hospital Authority (now Mersey Care National Health Service Trust) ex parte Munjaz. UKHL 58Google Scholar
Khadivi, A.N., Patel, R.C., Atkinson, A.R. and Levine, J.M. (2004) Association between seclusion and restraint and patient-related violence. Psychiatric Services. 55: 13111312.CrossRefGoogle ScholarPubMed
Sailas, E. and Fenton, M. (2000) Seclusion and restraint for people with serious mental illnesses. Cochrane Database Systematic Reviews. Issue 1. Art. No.: CD001163.CrossRefGoogle Scholar