Consumers’ and their supporters’ perspectives on barriers and strategies to reducing seclusion and restraint in mental health settings
Lisa M. Brophy A B , Catherine E. Roper C , Bridget E. Hamilton D E , Juan José Tellez F I and Bernadette M. McSherry F G HA Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 4/207 Bouverie Street, Carlton, Vic. 3010, Australia. Email: lbrophy@unimelb.edu.au
B Mind Australia, 86–92 Mount Street, Heidelberg, Vic. 3084, Australia.
C Centre for Psychiatric Nursing, School of Health Sciences, The University of Melbourne, Level 6 Alan Gilbert Building, 161 Barry Street, Carlton, Vic. 3053, Australia. Email: croper@unimelb.edu.au
D Department of Nursing, School of Health Sciences, The University of Melbourne, Level 6 Alan Gilbert Building, 161 Barry Street, Carlton, Vic. 3053, Australia. Email: bh@unimelb.edu.au
E St. Vincent’s Mental Health, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
F Melbourne Social Equity Institute, The University of Melbourne, 201 Grattan Street, Carlton, Vic. 3053, Australia.
G Melbourne Law School, University Square, 185 Pelham Street, Carlton, Vic. 3035, Australia. Email: bernadette.mcsherry@unimelb.edu.au
H Faculty of Law, Monash University, Wellington Road, Clayton, Vic. 3800, Australia.
I Corresponding author. Email: juan.tellez@unimelb.edu.au
Australian Health Review 40(6) 599-604 https://doi.org/10.1071/AH15128
Submitted: 5 July 2015 Accepted: 9 January 2016 Published: 3 March 2016
Journal Compilation © AHHA 2016
Abstract
Objective This paper examines the perspectives of consumers and their supporters regarding the use of seclusion and restraint in mental health settings.
Methods Five focus groups for consumers and five focus groups for supporters were conducted in four Australian cities and in one rural location. The 66 participants were asked about strategies to reduce or eliminate the use of seclusion and restraint in mental health settings.
Results All participants supported the reduction of the use of seclusion and restraint. Barriers to reducing these practices related to the environment, the effects of drug and alcohol issues, lack of a human rights focus and poor recognition of trauma, stigma and discrimination. Strategies for reducing or eliminating seclusion and restraint included workforce development, environmental and cultural changes.
Conclusions Participants clearly identified that the status quo needs to change and conveyed urgency for action. Participants suggested that the involvement of supporters and a range of consumer roles are integral to reducing the use of seclusion and restraint. The findings support the current policy emphasis of working towards the elimination of these practices.
What is known about the topic? Mental health policies across many jurisdictions support the reduction and elimination of restraint and seclusion. Evidence suggests those subjected to restraint and seclusion largely experience a range of harmful consequences. No studies focus on the views of supporters of consumers regarding the reduction and elimination of seclusion and restraint, whereas the views of consumers appear in a minority of international studies.
What does this paper add? The research enabled an opportunity to hear from people who have been personally affected by and/or have lived experience of these coercive practices. Participants identified local reforms that can uphold the human rights of consumers. They suggested practices to increase accountability, peer support and family involvement, areas that have not been analysed in depth in any of the seclusion and restraint literature.
What are the implications for practitioners? This paper will give healthcare services a deeper insight into how to reduce or eliminate restraint or seclusion from the perspective of those with lived experience.
Additional keywords: consumer voice, lived experience, qualitative research, service user perspective.
References
[1] National Mental Health Consumer and Carer Forum. Ending seclusion and restraint in Australian mental health services. Deakin West: National Mental Health Consumer and Carer Forum; 2009. Available at: http://www.nmhccf.org.au/documents/Seclusion%20&%20Restraint.pdf [verified 28 May 2014].[2] Australian Human Rights Commission. Report of the national inquiry into the human rights of people with mental illness. Canberra: Human Rights and Equal Opportunity Commission; 1993.
[3] National Mental Health Working Group. National safety priorities in mental health: a national plan for reducing harm. Canberra: Department of Health and Ageing, Commonwealth of Australia; 2005. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/DB6FC7B04519D195CA257BF000217B28/$File/safety.pdf [verified 28 May 2014].
[4] Cano N, Boyer L, Garnier C, Michel A, Belzeaux R, Chabannes JM, Samuelian JC, Harle JR. Patients’ perception of seclusion in psychiatry: ethical perspectives. Encephale 2011; 37 S4–10.
| Patients’ perception of seclusion in psychiatry: ethical perspectives.Crossref | GoogleScholarGoogle Scholar | 21600332PubMed |
[5] Frueh BC, Knapp RG, Cusack KJ, Grubaugh AL, Sauvageot JA, Cousins VC, Yim E, Robins CS. Special section on seclusion and restraint: patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv 2005; 56 1123–33.
| Special section on seclusion and restraint: patients’ reports of traumatic or harmful experiences within the psychiatric setting.Crossref | GoogleScholarGoogle Scholar | 16148328PubMed |
[6] Gerace A, Pamungkas DR, Oster C, Thomson D, Muir-Cochrane E. The use of restraint in four general hospital emergency departments in Australia. Australas Psychiatry 2014; 22 366–9.
| The use of restraint in four general hospital emergency departments in Australia.Crossref | GoogleScholarGoogle Scholar | 24820291PubMed |
[7] Haw C, Stubbs J, Bickle A, Stewart I. Coercive treatments in forensic psychiatry: a study of patients’ experiences and preferences. J Forens Psychiatry Psychol 2011; 22 564–85.
| Coercive treatments in forensic psychiatry: a study of patients’ experiences and preferences.Crossref | GoogleScholarGoogle Scholar |
[8] Kontio R, Joffe G, Putkonen H, Kuosmanen L, Hane K, Holi M, Valimaki M. Seclusion and restraint in psychiatry: patients’ experiences and practical suggestions on how to improve practices and use alternatives. Perspect Psychiatr Care 2012; 48 16–24.
| Seclusion and restraint in psychiatry: patients’ experiences and practical suggestions on how to improve practices and use alternatives.Crossref | GoogleScholarGoogle Scholar | 22188043PubMed |
[9] Mayers P, Keet N, Winkler G, Flisher AJ. Mental health service users’ perceptions and experiences of sedation, seclusion and restraint. Int J Soc Psychiatry 2010; 56 60–73.
| Mental health service users’ perceptions and experiences of sedation, seclusion and restraint.Crossref | GoogleScholarGoogle Scholar | 20053723PubMed |
[10] Kumble S, McSherry B. Seclusion and restraint: rethinking regulation from a human rights perspective. Psychiatry Psychol Law 2010; 17 551–61.
| Seclusion and restraint: rethinking regulation from a human rights perspective.Crossref | GoogleScholarGoogle Scholar |
[11] United Nations. United Nations convention on the rights of persons with disabilities. Available at: http://www.un.org/disabilities/convention/conventionfull.shtml [verified 30 October 2014].
[12] National Mental Health Commission. A contributing life: the 2012 national report card on mental health and suicide prevention. Sydney: National Mental Health Commission; 2012.
[13] Grubaugh AL, Frueh BC, Zinzow HM, Cusack KJ, Wells C. Patients’ perceptions of care and safety within psychiatric settings. Psychol Serv 2007; 4 193–201.
[14] Duxbury J. An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design. J Psychiatr Ment Health Nurs 2002; 9 325–37.
| An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zhslKlug%3D%3D&md5=3e6c688eb229b769a8b45f4f28662d7dCAS | 12060377PubMed |
[15] Meehan T, Vermeer C, Windsor C. Patients’ perceptions of seclusion: a qualitative investigation. J Adv Nurs 2000; 31 370–7.
| Patients’ perceptions of seclusion: a qualitative investigation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7jvVWhtQ%3D%3D&md5=f77c409f7b78767798d7135b54633978CAS | 10672095PubMed |
[16] Office of the Public Advocate. Restrictive interventions in Victoria’s disability sector. Issues for discussion and reform: discussion paper. Melbourne: Victorian Government; 2012. Available at: http://www.publicadvocate.vic.gov.au/our-services/publications-forms/55-restrictive-interventions-in-victorias-disability-sector-issues-for-discussion-and-reform?path= [verified 30 January 2016].
[17] Light EM, Robertson MD, Boyce P, Carney T, Rosen A, Cleary M, Hunt GE, O’Connor N, Ryan C, Kerridge IH. The lived experience of involuntary community treatment: a qualitative study of mental health consumers and carers. Australas Psychiatry 2014; 22 345–51.
| The lived experience of involuntary community treatment: a qualitative study of mental health consumers and carers.Crossref | GoogleScholarGoogle Scholar | 24963099PubMed |
[18] Owens N, Brophy L. Revocation of community treatment orders in a mental health service network. Australas Psychiatry 2013; 21 46–50.
| Revocation of community treatment orders in a mental health service network.Crossref | GoogleScholarGoogle Scholar | 23236095PubMed |
[19] Øvretveit J. Action evaluation of health programmes and changes: a handbook for a user-focused approach. Abingdon: Radcliffe Medical Press; 2002.
[20] Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006; 27 237–46.
| A general inductive approach for analyzing qualitative evaluation data.Crossref | GoogleScholarGoogle Scholar |
[21] Jaeger M, Konrad A, Rueegg S, Rabenschlag F. Patients’ subjective perspective on recovery orientation on an acute psychiatric unit. Nord J Psychiatry 2015; 69 188–95.
| Patients’ subjective perspective on recovery orientation on an acute psychiatric unit.Crossref | GoogleScholarGoogle Scholar | 25241849PubMed |
[22] Bowers L, Van Der Merwe M, Nijman H, Hamilton B, Noorthorn E, Stewart D, Muir-Cochrane E. The practice of seclusion and time-out on English acute psychiatric wards: the City-128 study. Arch Psychiatr Nurs 2010; 24 275–86.
| The practice of seclusion and time-out on English acute psychiatric wards: the City-128 study.Crossref | GoogleScholarGoogle Scholar | 20650373PubMed |
[23] Huckshorn K. Reducing seclusion and restraint use in mental health settings: core strategies for prevention. J Psychosoc Nurs Ment Health Serv 2004; 42 22–33.
| 15493493PubMed |
[24] Van Der Merwe M, Muir-Cochrane E, Jones J, Tziggili M, Bowers L. Improving seclusion practice: implications of a review of staff and patient views. J Psychiatr Ment Health Nurs 2013; 20 203–15.
| Improving seclusion practice: implications of a review of staff and patient views.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38fgslKnsw%3D%3D&md5=06aedf6c4273932e922c17e9a63dd798CAS | 22805615PubMed |
[25] United Nations Human Rights Council. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez. A/HRC/22/53. 2013. Available at: http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf [verified 1 January 2016].
