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Seclusion versus mechanical restraint in psychiatry – a systematic review

Published online by Cambridge University Press:  13 June 2019

Christian S. Gleerup ,
Søren D. Østergaard Open the ORCID record for Søren D. Østergaard [Opens in a new window]  and
Rasmus S. Hjuler
Christian S. Gleerup
Affiliation:
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Søren D. Østergaard
Affiliation:
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Rasmus S. Hjuler*
Affiliation:
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Department of Forensic Psychiatry, Aarhus University Hospital, Aarhus, Denmark
*
Author for correspondence: Rasmus S. Hjuler, Email: RASMPD@rm.dk
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Abstract

Objective:

Seclusion and mechanical restraint are coercive interventions used at psychiatric hospitals when patients are at imminent risk of harming themselves and/or others. Although these interventions have been used for decades, it remains unclear whether seclusion or mechanical restraint is superior in terms of efficacy and safety. Therefore, we aimed to systematically review studies comparing the intended and unintended effects of seclusion and mechanical restraint.

Methods:

A systematic search of PubMed and Embase was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Quantitative studies comparing the intended and unintended effects of seclusion and mechanical restraint were included.

Results:

The search identified 868 unique records. Fourteen of these (3 reporting on randomized controlled trials and 11 reporting on observational studies) met the predefined inclusion criteria. The study methodology including outcome measures varied significantly across studies. The results of the 11 studies using a subjective outcome measure (patient preference/emotions) were in favour of seclusion, while the 3 studies using an objective outcome measure (duration of coercion/need for transition to other coercive measure) favoured mechanical restraint. There was a high risk of residual confounding by indication and/or bias affecting the reported results.

Conclusion:

Based on the available literature, it cannot be determined whether seclusion is superior to mechanical restraint or vice versa. Further studies using stringent methodology are required to answer this question. A cautious conclusion based on this review is that the availability of both methods seems necessary – as both have their pros and cons.

Keywords

involuntary treatmentpsychiatricpsychosisaggressionself-injurious behaviour
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 31 , Issue 5 , October 2019 , pp. 237 - 245
Copyright
© Scandinavian College of Neuropsychopharmacology 2019 

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