Full access
Brief Reports
Published Online: 1 October 2014

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., and B. Christopher Frueh, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 65, Number 10
https://doi.org/10.1176/appi.ps.201300383
Track CitationsAdd to favorites
PDF/EPUBFormats

Abstract

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.

Formats available

You can view the full content in the following formats:

View PDF/EPUBView Full Text

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Shamrock Ranch, by Peter Hurd, 1962. Watercolor, 12 × 16 inches. New Mexico Museum of Art, Santa Fe. Gift of the family of Edythe C. Mattone, 2005.

Psychiatric Services
Volume 65 • Number 10 • October 2014
Pages: 1273 - 1276
PubMed: 25022602

History

Published online: 1 October 2014
Published in print: October 2014

Authors

Details

Alok Madan, Ph.D., M.P.H.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Jeffrey J. Borckardt, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Anouk L. Grubaugh, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Carla Kmett Danielson, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Stephen McLeod-Bryant, M.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Harriet Cooney, M.S.N.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Joan Herbert, M.S.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
Susan J. Hardesty, M.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author
B. Christopher Frueh, Ph.D.
Dr. Madan and Dr. Hardesty are with the Menninger Clinic, Houston, Texas (e-mail: [email protected]) 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.
View all articles by this author

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard
Tips for downloading citations

View Options

View options

PDF/EPUB

View PDF/EPUB

Full Text

View Full Text

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Item saved, go to cart
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share

×

As described within the American Psychiatric Association (APA)'s Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.