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Reducing the use of seclusion in a secure service for women

Published online by Cambridge University Press:  28 October 2014

Clive G Long ,
Rachel West ,
Matthew Afford ,
Lesley Collins  and
Olga Dolley
Clive G Long*
Affiliation:
University of Northampton, UK St Andrew’s, Cliftonville, Northampton, UK
Rachel West
Affiliation:
St Andrew’s, Cliftonville, Northampton, UK
Matthew Afford
Affiliation:
St Andrew’s, Cliftonville, Northampton, UK
Lesley Collins
Affiliation:
St Andrew’s, Cliftonville, Northampton, UK
Olga Dolley
Affiliation:
St Andrew’s, Cliftonville, Northampton, UK
*
Correspondence to: Professor Clive Long, St Andrew’s Academic Centre, Cliftonville, Northampton NN1 5DG, UK. E-mail: clong@standrew.co.uk
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Abstract

Reducing the use of seclusion to deal with challenging behaviour is a priority in secure services for women. This study describes the concurrent introduction of a series of initiatives based on recovery principles and the full involvement of patients in their risk management plans.

Following change implementation, the first 19 patients who had completed one year of treatment were matched with 19 patients who had completed their first year of treatment before change.

A significant decline in both the number of seclusions and risk behaviour post-change was complemented by improved staff ratings of institutional behaviour, increased treatment engagement and a reduction in time spent in medium security. Staff and patients differed in terms of their ratings of the most effective strategies introduced. Patients favoured the Relational Security item of increased individual engagement and timetabled Behaviour Chain Analysis sessions. Staff viewed on ward training and use of de-escalation techniques as most effective.

Findings confirm results from mixed gender forensic mental health samples that seclusion can be successfully reduced without an increase in patient violence or alternative coercive strategies. Limitations of the study are discussed along with the need for future evaluations to address issues of fidelity and utilise vigorously designed case studies.

Keywords

Womenseclusionsecure services
Type
Original Research Articles
Information
Journal of Psychiatric Intensive Care , Volume 11 , Issue 2 , August 2015 , pp. 84 - 94
Copyright
© NAPICU 2014 

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References

Allen, E. (2010) Relational Security. London: Department of Health.Google Scholar
Bonner, G., Lowe, T., Rawcliffe, D. and Wellman, N. (2002) Trauma for all: a pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. Journal of Psychiatric & Mental Health Nursing. 9(4): 465–473.Google Scholar
Bowers, L. (2002) Dangerous and Severe Personality Disorder: Response and role of the psychiatric team. London: Routledge.Google Scholar
Bowers, L., Brennan, G. and Fisher, C. (2006) Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: city nurses. Journal of Psychiatric & Mental Health Nursing. 13: 165–172.CrossRefGoogle ScholarPubMed
Bowers, L., Hackney, D., Nijman, H., Grange, A., Allan, T., Simpson, A., Hall, C. and Eyres, S (2007) A Longitudinal Study of Conflict and Containment on Acute Psychiatric Wards: Report to the DH Policy Research Programme. London: City University.Google Scholar
Bowers, L., Stewart, D., Papadopoulos, C., Dack, C., Rass, J., Khanom, H. and Jeffery, D. (2011) Inpatient violence and aggression: a literature review. Report from the Conflict and Containment Reduction Research Programme . London: Institute of Psychiatry, King’s College, London, 196, pp.Google Scholar
Braham, L., Jones, D. and Hollin, C.R. (2008) The Violent Offender Treatment Program (VOTP): development of a treatment program for violent patients in a high security psychiatric hospital. International Journal of Forensic Mental Health. 7: 157–172.Google Scholar
Champagne, T. and Stromberg, N. (2004) Sensory approaches in inpatient psychiatric settings. Journal of Psychosocial Nursing. 42(9): 1–8.Google ScholarPubMed
Coid, J., Kahtan, N., Gault, S. and Jarman, B. (2000a). Women admitted to secure forensic psychiatry services: I. Comparison of women and men. Journal of Forensic Psychiatry. 11: 275–295.Google Scholar
Coid, J., Kahtan, N., Gault, S. and Jarman, B. (2000b). Women admitted to secure forensic psychiatry services: II. Identification of categories using cluster analysis. Journal of Forensic Psychiatry. 11: 296–315.CrossRefGoogle Scholar
Cotton, N.S. (1995) Seclusion as therapeutic management: an invited commentary. American Journal of Orthopsychiatry. 65: 245–248.CrossRefGoogle Scholar
Daffern, M. and Howells, K. (2007) Antecedents for aggression and the function analytic approach to the assessment of aggression and violence in personality disordered patients within secure settings. Personality & Mental Health. 1: 126–137.CrossRefGoogle Scholar
Daffern, M., Howells, K. and Ogloff, J.R.P. (2007) The interaction between individual characteristics and the function of aggression in forensic psychiatric inpatients. Psychiatry, Psychology & Law. 14: 17–25.Google Scholar
Davies, W. (2004) The RAID Manual: a relentlessly positive approach to working with extreme behaviours. Leicester: ATP Press.Google Scholar
Department of Health (2008) Code of Practice: Mental Health Act 1983. London: The Stationary Office.Google Scholar
Douglas, K.S., Hart, S.D., Webster, C.D. and Belfrage, H. (2013) HCR-20 Version 3: Assessing risk for violence. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University.Google Scholar
Fisher, W.A. (2003) Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital. Journal of Psychiatric Practice. 9: 7–15.Google Scholar
Fowler, N.A. (2006) Aromatherapy used as an integrative tool for crisis management by adolescents in a residential treatment centre. Journal of Child & Adolescent Psychiatric Nursing. 19: 69–76.Google Scholar
Freuh, B.C., Knapp, R.G., Cusack, K.J., Gmbaugh, A.L., Sauvageot, J.A., Cousins, V.C., Yim, E., Robins, C.S., Monnier, J. and Hiers, T.G. (2005) Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services. 56: 1123–1133.Google Scholar
Gadon, L., Johnstone, L. and Cooke, D. (2006) Situational variables and institutional violence: a systematic review of the literature. Clinical Psychology Review. 26: 515–534.CrossRefGoogle ScholarPubMed
Gaskin, C.J., Elsom, S.J. and Happell, B. (2007) Interventions for reducing the use of seclusion in psychiatric facilities. British Journal of Psychiatry. 191: 298–303.Google Scholar
Gournay, K., Benson, R. and Rogers, P. (2008) Inpatient care and management. In: Soothill, K., Rogers, P., Dolan, M. (eds). Handbook of Forensic Mental Health. Uffculme, Collumpton, Devon: Willan Publishing, pp 525–554.Google Scholar
Greene, R.W., Ablon, J.S. and Martin, A. (2006) Use of collaborative problem solving to reduce seclusion and restraint in child and adolescent services. Psychiatric Services. 57: 610–612.Google Scholar
Gudjonsson, G.H., Robe-Hesketh, S. and Wilson, C. (2000) Violent incidents on a medium secure unit: the target of assault and the management of incidents. The Journal of Forensic Psychiatry. 11(1): 105–118.CrossRefGoogle Scholar
Halder, N. (2013) Seclusion reduction within secure women’s services. Presented at 10th Anniversary National Conference Research in Forensic Mental Health Services Institute of Psychiatry, London, 14th March.Google Scholar
Huckshorn, K.A. (2004) Reducing seclusion and restraint use in mental health settings: core strategies for prevention. Journal of Psychological Nursing & Mental Health Services. 42: 22–33.Google Scholar
Kozar, C. (2010) Treatment readiness and the therapeutic alliance. In: Day, A., Casey, S., Ward, T., Howells, K., Vess, J. (eds). Transitions to Better Lives: Offender readiness and rehabilitation. Cullompton, Devon: Willan Publishing, pp 195–213.Google Scholar
Leggett, J. and Silvester, J. (2003) Care staff attributions for violent incidents involving male and female patients: a field study. British Journal of Clinical Psychology. 42: 393–406.CrossRefGoogle ScholarPubMed
Lidz, C.W., Mulvey, E.P. and Gardner, W. (1993) The accuracy of predictions and violence to others. Journal of the American Medical Association. 269: 1007–1011.CrossRefGoogle ScholarPubMed
Linehan, M. (1993) The Cognitive Behavioural Treatment of Borderline Personality Disorder. New York: Guildford Press, 558, pp.Google Scholar
Long, C.G., Dolley, O. and Hollin, C.R. (2011) Women in medium secure care: tracking treatment progress for changes in risk profiles and treatment engagement. Journal of Psychiatric & Mental Health Nursing. 18: 425–431.CrossRefGoogle ScholarPubMed
Long, C.G., Anagnostakis, K., Banyard, E., Silaule, P. and Dolley, O. (2014) Patient and staff experience of a ward based risk management system. Forensic Update. 113: 7–18.CrossRefGoogle Scholar
Maguire, T., Young, R. and Martin, J. (2012) Seclusion reduction in a forensic mental health setting. Journal of Psychiatric & Mental Health Nursing. 19: 97–106.CrossRefGoogle Scholar
McKinnon, B. and Cross, W. (2008) Occupational violence and assault in mental health nursing: a scoping project for a Victorian Mental Health Service. International Journal of Mental Health Nursing. 17: 9–17.CrossRefGoogle ScholarPubMed
Nijman, H.L.I., Joost, M.L.G. and Campo, M.L.G. (2002) Situational determinants of inpatient self-harm. Suicide & Life Threatening Behaviour. 32(2): 167–175.Google Scholar
Paterson, B., Bradley, P., Stark, C., Saddler, D., Leadbetter, D. and Allen, D. (2003) Deaths associated with restraint use in health and social care in the UK. The results of a preliminary survey. Journal of Psychiatric & Mental Health Nursing. 10: 3–15.Google Scholar
Sailas, E.E.S. and Fenton, M. (2000) Seclusion and restraint for people with serious mental illness. Cochrane Database of Systematic Reviews. 2000(1): CD 001163. http://dx.doi.org/10.1002/14651858.CD001163.Google Scholar
Schreiner, G.M., Crafton, C.G. and Sevin, J.A. (2004) Decreasing the use of mechanical restraints and locked seclusion. Administration & Policy in Mental Health. 31: 449–463.Google Scholar
Sigafoos, J. and Kerr, M. (1994) Provision of leisure activities for the reduction of challenging behaviours. Behavioural Intervention. 1: 43–53.Google Scholar
Smith, G.M., Davis, R.H., Bixler, E.O., Lin, H, Altenor, A., Altenor, R.J., Hardenstine, B.D. and Kopchick, G.A. (2005) Pennsylvania State Hospital system’s seclusion and restraint reduction program. Psychiatric Services. 56: 1115–1122.CrossRefGoogle ScholarPubMed
SPSS Inc (2009) PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.Google Scholar
Sullivan, A.M., Bezmen, J., Barron, C.T., Rivera, J., Curley-Casey, L. and Marine, D. (2005) Reducing restraints: alternatives to restraints on an inpatient psychiatric service – utilizing safe and effective methods to evaluate and treat the violent patient. Psychiatric Quarterly. 76(1): 51–65.Google Scholar
Taxis, J.C. (2002) Ethics and praxis: alternative strategies to physical restraint and seclusion in a psychiatric setting. Issues in Mental Health Nursing. 23: 157–170.Google Scholar
United Kingdom Central Council for Nursing, Midwifery and Health Visiting (2001) The Recognition, Prevention and Therapeutic Management of Violence in Mental Health Care. London: Health Services Research Department, Institute of Psychiatry, 124, pp.Google Scholar
van der Merwe, M., Bowers, L., Jones, J., Muir-Cochrane, E. and Tziggili, M. (2009) Seclusion: a literature review. London: City University, 73pp.Google Scholar
Yudofsky, S.C., Silver, J.M., Wynn Jackson, M.D., Endicott, J. and Williams, D. (1986) The Overt Aggression Scale for the objective rating of verbal and physical aggression. American Journal of Psychiatry. 143(1): 35–39.Google Scholar