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The use of seclusion and emergency medication in a hospital for people with learning disability

Published online by Cambridge University Press:  03 January 2018

M. E. H. Rangecroft ,
S. P. Tyrer  and
T. P. Berney
M. E. H. Rangecroft*
Affiliation:
Regional Department of Psychotherapy, Royal Victoria Infirmary, Newcastle upon Tyne
S. P. Tyrer
Affiliation:
Prudhoe Hospital, Prudhoe, Northumberland
T. P. Berney
Affiliation:
Prudhoe Hospital, Prudhoe, Northumberland
*
Dr S. P. Tyrer, Prudhoe Hospital, Prudhoe, Northumberland NE42 5NT
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Abstract

Background

The management of disturbed behaviour in facilities for those with learning disabilities involves a spectrum of approaches including the prescription of emergency medication, restraint and seclusion. The use of these techniques has recently come under close scrutiny.

Method

All incidents requiring emergency medication or seclusion that occurred in a large hospital for those with learning disabilities were studied over a six-months period. The precipitating factors, course and outcome of those who had received emergency medication or seclusion were then examined.

Results

In all, 286 incidents involving 72 individuals occurred during the study period. The episodes requiring seclusion comprised 19% of all incidents. Two-thirds of the patients involved were male but six female patients accounted for 36% of all incidents. During the second part of the study, when the staff knew that the treatments used were being monitored, there was a significant reduction in use of restraint and emergency drugs given intramuscularly. Patients receiving seclusion were judged to have a better outcome one hour after the onset of the incident compared with those who received medication.

Conclusions

Despite concerns about the use of seclusion, the results of this survey suggest that procedures that remove the patient from the environment contributing to the disturbance may have certain advantages in this population.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 3 , March 1997 , pp. 273 - 277
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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References

American Psychiatric Anociation (1987) Diagnostic and Statistical Manual for Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Anderson, W H. & Reevas, K. R. (1991) Chemical restraint: An idea whose time has gone. Administration and Policy in Mental Health. 18, 205–208.Google Scholar
Angold, A. A. Picides, A. (1993) Seclusion on an adolescent unit. Journal of Child Psychobgy and Psychiatry. 34, 975–989.Google Scholar
Bisconer, S. W., Zhang, X. & Sine, L. F. (1995) Impact of a psychotropic medication and physical restraint review process on adults with mental retardation, psychiatric diagnoses, and challenging behaviors. Journal of Developmental and Physical Disabilities. 7, 123–125.Google Scholar
Brooks, K. L., Mulaik, J. S., Gilead, M. P., et al (1994) Patient overcrowding in psychiatric hospital units: Effects on seclusion and restraint. Administration and Policy in Mental Health. 22, 133–144.Google Scholar
Convey, J. (1986) A record of violence. Nursing Times, 82, 36–38.Google Scholar
Department of Heath (1992) Report of the Committee of Inquiry into Complaints about Ashworth Hospital. London: Her Majesty's Stationery Office.Google Scholar
Emerson, E. (1995) Challenging Behaviour: Analysis and Intervention in People with teaming Disabilities, pp. 67–78. Cambridge: Cambridge University Press.Google Scholar
Fottrell, E. (1980) A study of violent behaviour among patients in psychiatric hospitals. British Journal of Psychiatry. 138, 216–221.Google Scholar
Larkin, E., Murtagh, S. & Jones, S. (1988) A preliminary study of violent incidents in a special hospital (Rampton). British Journal of Psychiatry. 153, 226–231.Google Scholar
Manchester, D. (1993) Neuroleptics, learning disability and the community: Some history and mystery. British Medical Journal. 307, 184–187.Google Scholar
Mayor, J., Bhate, M., Firth, H., et al (1990) Facilities for mentally impaired patients: Three years experience of a semi-secure unit. Psychiatric Bulletin, 14, 333–335.Google Scholar
McLaren, S., Frederick, W., Browne, A., et al (1990) A study of psychotropic medication given ‘as required’ in a regional secure unit. British Journal of Psychiatry, 158, 732–735.CrossRefGoogle Scholar
Norris, M. K., & Kennedy, C. W. (1992) The view from within: How patients perceive the seclusion process. Journal of Psychosocial Nursing and Mental Health Services. 30, 7–13.Google Scholar
Reid, A. M. (1985) Psychiatry and mental handicap. In Mental Handicap (eds Craft, M., Bicknell, J. & Hollins, S.), pp. 312–332. London: Baillière Tindall.Google Scholar
Royal Collece of Psychiatrists (1995) Strategies for the Management of Disturbed and Violent Patients in Psychiatric Units. Council Report CR41. London: Royal College of Psychiatrists.Google Scholar
Schwab, P. J. & Lahmayer, B. (1979) The uses of seclusion on a general psychiatric unit (letter). Journal of Clinical Psychiatry, 40. 228.Google Scholar
Soioff, P. H. (1987) Ennergency management of violent patients. In American Psychiatric Association Annual Review. vol. 6, pp. 510–536. Washington, DC: APA.Google Scholar
Soioff, P. H. & Turner, S. M. (1981) Patterns of seclusion: A prospective study. Journal of Nervous and Merrtal Disease. 172, 282–286.Google Scholar
Tardiff, K. (1992) The current state of psychiatry in the treatment of violent patients. Archives of General Psychiatry. 49, 493–499.Google Scholar
Thompson, C. (1994) The use of high-dose antipsychotic medication: A consensus statement. British journal of Psychiatry 164, 448–458.Google Scholar
Thompson, P. (1988) The use of seclusion in psychiatric hospitals in the Newcastle area. British journal of Psychiatry. 149, 471–474.Google Scholar
Wressell, S. E., Tyrer, S. P. & Berney, T. P. (1990) Reduction in antipsychotic drug dosage in mentally handicapped patients: A hospital study. British Journal of Psychiatry. 157, 101–106.Google Scholar
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