Restraint and seclusion in psych setting

[burnay76]

I worked in the private sector in a psych facility for four years prior to my currect position in a state psych facility in NY State. In the private hospital the use of seclusion was always preferrable to use of mechanical restraints (although brief hands on manual restraint was often neccessary to move the patient into seclusion (seclusion is a misnomer as there is always a staff present on 1:1 during any such event). In the state facility use of seclusion is an option of last resort and mechanically restraining the patient is preferred if the use of a manual hands-on restraint is not effective or not appropriate.

Anecdotally, In those four years I never once was hit by a patient (and 2 and a half of those years was in a crisis center where they are most acute). I have been at the state facility 2 months and had a patient hit me today after stopping her from self abusing (it was a minor thing and didn't hurt me in the least - I wouldn't have approved a restraint at this point but the nurse Administrator was present and gave the order).

For those of you working psych or who have experience in the field, what are your thoughts regarding the use of restraint versus seclusion. Seclusion seems less restrictive to me and, in my experience, removes the patient from whatever is going on and gives them the opportunity to regroup in a safe environment. I'd rather get a "time out" that a "tie down"

Also - if you know of any scholarly writings supporting the use of one over the other that would be great. I have been unable to get the restraint committee to give me information that indicates our policy is evidence based.

for those who may not remember or use different terms:

manual restraint = hands on restraint

mechanical restraint= use of restraining gear (4 point leathers in this facility)

Seclusion= placement in a bare room with a plexiglass window and somewhat padded walls and floor.

Thanks!

Scott

[scribblerpnp]

I worked in psych for while dealing mainly with teenagers. I preferred seclusion the majority of the time for the same reasons you stated. For teenagers it worked pretty well. Plus there was always the worry of attention-seeking behaviors with restraint. Some of them liked to show off and make a scene, which was something that was more difficult with seclusion. The only times I preferred manual was if there was self- harm involved, like biting. I worked in a private hospital. I don't know of any research which refers to this. Hopefully someone else will respond.

[MacNinni]

Hi! I have worked for several years with teen, adult and geri psyche patients. I have found that all respond better to seclusion. When upset, the chaos of the unit about them is too much to handle. Of course, there is someone to provide 1:1 at these times.

[skywise]

There has been a lot of research and a nation wide emphasis to reduce and hopefully eliminate the use of seclusion and restraint. I work with children and adolescents in a state psychiatric hospital. Our nurse manager changed the requirements/criteria for the use of mechanical restraint such that the Only reason for the use of mechanical restraint is for the prevention of self abusive behavior, usually only used after seclusion has failed because of severe self abuse(severe head banging). The APNA has been working on this and has published position papers.

[elkpark]

Federal and state (in my state; probably in yours, too) rules/regs require that clients be treated in the least restrictive setting that will meet their needs -- and seclusion is "officially" considered a less restrictive intervention than restraints, so it should always be used first (or you should document in the record why seclusion would not have been a sufficient/appropriate intervention to keep the client safe). If someone in locked seclusion is continuing to bang her/his head against the wall, or attempt to harm her/himself in some other way, then physical restraint would be the next step.

In my state, the state facilities follow this principle as well as the community providers (I worked as a state and Federal psych surveyor for several years in my state, so I was very familiar with the practices in all the psych units and hospitals in the state), and, in fact, it often appeared that the staff in state facilities were working harder to come up with other options besides restraint and seclusion than some of the community providers were. Your experience at your facility in NY is not necessarily universal.