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Innovation and pragmatism required to reduce seclusion practices

Published online by Cambridge University Press:  28 October 2016

John Tully ,
Leo McSweeney ,
Katie-Lynn Harfield ,
Cindie Castle  and
Mrigendra Das
John Tully*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry and South London and Maudsley Foundation Trust, London, UK
Leo McSweeney
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
Katie-Lynn Harfield
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
Cindie Castle
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
Mrigendra Das
Affiliation:
High Dependency Service, Broadmoor Hospital, Crowthorne, UK
*
*Address for correspondence: Dr. John Tully, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, 16 De Crespigny Park, Camberwell, London SE5 8AF, UK. (Email: john.tully@kcl.ac.uk)
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Abstract

Seclusion may be harmful and traumatic to patients, detrimental to therapeutic relationships, and can result in physical injury to staff. Further, strategies to reduce seclusion have been identified as a potential method of improving cost-effectiveness of psychiatric services. However, developing alternative strategies to seclusion can be difficult. Interventions to reduce seclusion do not lend themselves to evaluation using randomized controlled trials (RCTs), though comprehensive literature reviews have demonstrated considerable non-RCT evidence for interventions to reduce seclusion in psychiatric facilities. In the UK, a recent 5-year evaluation of seclusion practice in a high secure UK hospital revealed reduced rates of seclusion without an increase in adverse incidents. To assess the effect of a novel intervention strategy for reduction of long-term segregation on a high secure, high dependency forensic psychiatry ward in the UK, we introduced a pilot program involving stratified levels of seclusion (“long-term segregation”), multidisciplinary feedback and information sharing, and a bespoke occupational therapy program. Reduced seclusion was demonstrated and staff feedback was mainly positive, indicating increased dynamism and empowerment on the ward. A more structured, stratified approach to seclusion, incorporating multidisciplinary team-working, senior administrative involvement, dynamic risk assessment, and bespoke occupational therapy may lead to a more effective model of reducing seclusion in high secure hospitals and other psychiatric settings. While lacking an evidence base at the level of RCTs, innovative, pragmatic strategies are likely to have an impact at a clinical level and should guide future practice and research.

Keywords

Information sharingmultidisciplinary feedbacknonpharmacological interventionsoccupational therapyrelational securitystaff educationsupervised confinement
Type
Opinion
Information
CNS Spectrums , Volume 21 , Issue 6 , December 2016 , pp. 424 - 429
Copyright
© Cambridge University Press 2016 

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Footnotes

The authors would like to acknowledge the input and experience of all nursing staff on the ward and all allied health professionals, without whose efforts this project would not have been possible.

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