Thursday, July 21, 2022

Efforts to Reduce Use of Seclusion, Restraint at Pennsylvania State Hospitals Found Successful

The frequency and duration of mechanical restraint, physical restraint, and seclusion on patients committed to six Pennsylvania state hospitals and two forensic centers significantly declined between 2011 and 2020, according to a report published yesterday in Psychiatric Services. During the same period, incidents of assault, aggression, and self-injurious behavior also declined. 

“Uses of seclusion and restraints can be reduced or eliminated in both civil and forensic populations, with benefits to both the persons being served and their support staff,” wrote Gregory M. Smith, M.S., of Allentown State Hospital, Aidan Altenor, Ph.D., of Wernersville State Hospital, and colleagues. 

The Pennsylvania Department of Human Services, Office of Mental Health and Substance Abuse Services, was an early pioneer in reducing the use of seclusion and restraints in its state hospitals and forensic centers, according to Smith, Altenor, and colleagues. “This renaissance in the care of people with mental illness has spread worldwide, with seclusion and restraint no longer viewed as treatments, but rather as treatment failures,” they wrote.

The authors analyzed data on 3,989 adults committed to the Clarks Summit, Danville, Norristown, Torrance, Wernersville, and Warren State Hospitals in Pennsylvania and 3,548 adults committed to the Regional Forensic Centers at Norristown and Torrance State Hospitals between January 1, 2011, and December 30, 2020.

During the study period, seclusion was used at the civil hospitals three times for a total of 189 minutes and was last used in July 2013; mechanical restraint was applied 118 times for a total of 16,611 minutes and was last used in September 2015; and physical restraint was used 6,972 times for a total of 31,916 minutes. Physical restraint use decreased from a high of 2.62 uses per 1,000 days in 2013 to 1.9 per 1,000 days in 2020, the authors noted. Additionally, the average length of time a person was held in physical restraint declined from 6.6 minutes per episode in 2012 to 2.4 minutes or less from 2018 to 2020.

At forensic hospitals, containment procedures also declined over the study period. Seclusion was used once, in 2012, for 345 minutes; mechanical restraint was used 10 times for a total of 432 minutes and was last used in 2014; physical restraint was used 2,546 times for a total of 8,606 minutes. Physical restraint use also significantly declined in forensic hospitals—from a high of 3.8 episodes per 1,000 days in 2012 to 2.5 in 2020. The duration of physical restraint episodes significantly declined from 6.8 minutes in 2011 to 2.5 minutes or less from 2017 to 2020.

Incidents of aggression, defined as a verbal or physical threat of injury, were reported 12,167 times during the study period and were the leading reason for physical restraint use, accounting for 32.8% of use of the procedure. The number of patient-to-staff assaults, incidents of self-injurious behavior, and patient-to-patient assaults all declined during the study period.

“Pennsylvania’s ongoing emphasis on staff training, de-escalation techniques, [and] psychiatric emergency response teams … contribute to a person-centered approach to care and treatment with significant benefits to staff and patients,” the authors wrote. “Marked reduction in aggression, patient-to-patient and patient-to-staff assaults, and instances of self-injurious behaviors in the civil hospitals and forensic centers during this period all reinforce the utility of this approach.”

For related information, see the Psychiatric News article “Ensuring Patient, Staff Safety Begins With Supportive Management, Staff Training.”

(Image: iStock/gorodenkoff)


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