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Brief Reports   |    
Efforts to Reduce Seclusion and Restraint Use in a State Psychiatric Hospital: A Ten-Year Perspective
Alok Madan, Ph.D., M.P.H.; Jeffrey J. Borckardt, Ph.D.; Anouk L. Grubaugh, Ph.D.; Carla Kmett Danielson, Ph.D.; Stephen McLeod-Bryant, M.D.; Harriet Cooney, M.S.N.; Joan Herbert, M.S.; Susan J. Hardesty, M.D.; B. Christopher Frueh, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300383
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Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: amadan@menninger.edu) and with the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Borckardt is with the Department of Psychiatry and Behavioral Sciences and the Department of Anesthesia and Perioperative Medicine, Dr. Grubaugh and Dr. Danielson are with the Department of Psychiatry and Behavioral Sciences, Ms. Cooney is with the Institute of Psychiatry, and Ms. Herbert is with the Office of Organizational Performance, all at the Medical University of South Carolina, Charleston. Dr. McLeod-Bryant is with the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee. Dr. Frueh is with the Menninger Clinic, Houston, Texas, and the Department of Psychology, University of Hawaii, Hilo.

Copyright © 2014 by the American Psychiatric Association


Objective  The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time.

Methods  This follow-up study examined archival data by using a longer preintervention baseline phase and examined the sustainability of intervention gains in the absence of a research agenda. Over ten years, 3,040 seclusion and restraint incidents were analyzed across 254,491 patient-days.

Results  The extended baseline phase (N=38 months) exhibited a linear trend upward in seclusion and restraint use, and the formal intervention period and subsequent follow-up periods (N=82 months) showed a stabilization effect (p<.001).

Conclusions  The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice—even in the face of potentially disruptive administrative and environmental changes.

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Figure 1 Ten-year rate (per 1,000 patient-days) of seclusion and restraint at a state psychiatric hospital


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