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Am J Psychiatry 1994; 151:1584-1591
Copyright © 1994 by American Psychiatric Association
Restraint and seclusion: a review of the literature
WA Fisher
New York State Office of Mental Health, Creedmoor Psychiatric Center, Queens Village.
OBJECTIVE: The author reviewed the literature published since 1972
concerning restraint and seclusion. METHOD: The review began with a
computerized literature search. Further sources were located through
citations from articles identified in the original search. RESULTS: The
author synthesized the contents of the articles reviewed using the
categories of indications and contraindications; rates of seclusion and
restraint as well as demographic, clinical, and environmental factors that
affect these rates; effects on patients and staff; implementation; and
training. CONCLUSIONS: The literature on restraint and seclusion supports
the following. 1) Seclusion and restraint are basically efficacious in
preventing injury and reducing agitation. 2) It is nearly impossible to
operate a program for severely symptomatic individuals without some form of
seclusion or physical or mechanical restraint. 3) Restraint and seclusion
have deleterious physical and psychological effects on patients and staff,
and the psychiatric consumer/survivor movement has emphasized these
effects. 4) Demographic and clinical factors have limited influence on
rates of restraint and seclusion. 5) Local nonclinical factors, such as
cultural biases, staff role perceptions, and the attitude of the hospital
administration, have a greater influence on rates of restraint and
seclusion. 6) Training in prediction and prevention of violence, in
self-defense, and in implementation of restraint and/or seclusion is
valuable in reducing rates and untoward effects. 7) Studies comparing
well-defined training programs have potential usefulness.
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