Reducing use of seclusion on a male medium secure forensic ward
The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients’ feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-in...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-02-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/13/1/e002576.full |
| _version_ | 1797222487027613696 |
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| author | Mark Hancock David Francis Hunt Kathryn Amy Rowsell Ayodele Akinbola Tsitsi Nyambayo Zoe Jackson |
| author_facet | Mark Hancock David Francis Hunt Kathryn Amy Rowsell Ayodele Akinbola Tsitsi Nyambayo Zoe Jackson |
| author_sort | Mark Hancock |
| collection | DOAJ |
| description | The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients’ feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions. |
| first_indexed | 2024-03-08T00:17:11Z |
| format | Article |
| id | doaj.art-8b2e7c74c91e4da0ad6eeaed5a9d1126 |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-04-24T13:22:06Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-8b2e7c74c91e4da0ad6eeaed5a9d11262024-04-04T12:55:09ZengBMJ Publishing GroupBMJ Open Quality2399-66412024-02-0113110.1136/bmjoq-2023-002576Reducing use of seclusion on a male medium secure forensic wardMark Hancock0David Francis Hunt1Kathryn Amy Rowsell2Ayodele Akinbola3Tsitsi Nyambayo4Zoe Jackson5Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UKSchool of Psychology, University of Exeter Faculty of Health and Life Sciences, Exeter, UKForensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UKForensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UKForensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UKForensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UKThe reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients’ feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions.https://bmjopenquality.bmj.com/content/13/1/e002576.full |
| spellingShingle | Mark Hancock David Francis Hunt Kathryn Amy Rowsell Ayodele Akinbola Tsitsi Nyambayo Zoe Jackson Reducing use of seclusion on a male medium secure forensic ward BMJ Open Quality |
| title | Reducing use of seclusion on a male medium secure forensic ward |
| title_full | Reducing use of seclusion on a male medium secure forensic ward |
| title_fullStr | Reducing use of seclusion on a male medium secure forensic ward |
| title_full_unstemmed | Reducing use of seclusion on a male medium secure forensic ward |
| title_short | Reducing use of seclusion on a male medium secure forensic ward |
| title_sort | reducing use of seclusion on a male medium secure forensic ward |
| url | https://bmjopenquality.bmj.com/content/13/1/e002576.full |
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