Recovery Model Helps Reduce Use of Seclusion, Restraint in Large Hospital System

From 2001 to 2010, the use of mechanical restraint and seclusion in the Pennsylvania state hospital system declined significantly after incorporation of targeted strategies and a recovery-oriented model of care, according to a report in Psychiatric Services in Advance titled “Correlation Between Reduction of Seclusion and Restraint and Assaults by Patients in Pennsylvania’s State Hospitals.” Additionally, patient-to-patient assaults declined slightly, although patient-to-staff assaults were unaffected.

Researchers affiliated with the Pennsylvania state hospital system conducted a prospective study to assess the use of seclusion and restraint from 2001 through 2010. They examined 12,900 anonymized records involving the 1,801 civilly committed individuals who were physically or mechanically restrained and secluded in the nine civil state hospitals during the study period. They found that the use of mechanical restraint declined significantly from .37 to .08 episodes per 1,000 days, and the use of seclusion declined significantly from .21 to .01 episodes per 1,000 days.

The researchers attribute the change to the incorporation of “The Six Core Strategies for Reducing Seclusion and Restraint Use” issued by the National Association of State Mental Health Program Directors. These strategies include better leadership, data transparency, use of clinical alerts, workforce development, policy changes, enhanced use of response teams, implementation of dialectical behavior therapy, and discontinuation of the use of PRN (or "as needed") orders) to prevent or limit agitation, anxiety, and physical aggression. They also attribute the change in part to a systemwide recovery-oriented model of care. “Pennsylvania’s commitment to a recovery approach has transformed its service-delivery system to emphasize community services and supports,” they said. “This commitment is the overall reason for the significant reduction in use of seclusion and restraint.”

For more on how hospitals are dealing with seclusion and restraint concerns, see the Psychiatric News article "Psychiatric Hospital Aesthetics Affect Seclusion, Restraint Use."

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