An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital

Objective: The author reviews and evaluates a variety of interventions that were considered to have contributed to the successful reduction of reliance on the use of seclusion and restraint in a public psychiatric hospital for adult patients with severe and persistent psychiatric impairments. Methods: A multiple regression analysis was applied to monthly seclusion and restraint data covering the period from 1997 to 2002. The independent variables were each of the component efforts to reduce reliance on seclusion and restraint at the hospital: changes in the criteria for administrative review of incidents of seclusion and restraint, changes in the composition of the case review committee, development of a behavioral consultation team, enhancement of standards for behavioral assessments and plans, and improvements in the staff-patient ratio. Results: The use of seclusion and restraint was 75 percent lower during the final year of the five-year study period than it was during the first year. The only variable that was significantly associated with reduction in the use of seclusion and restraint was changes in the process for identifying critical cases and initiating a clinical and administrative case review. Conclusion: The results of this analysis underscore the importance of clinical and administrative priorities in efforts to reduce the use of seclusion and restraint in public psychiatric hospitals.