The power of day-to-day motivational techniques and family participation in reducing seclusion : a comparison of two admission wards with and without a seclusion prevention protocol

Abstract

The use of seclusion in psychiatric practice is a controversial issue in the Netherlands, as a number of recent studies have shown seclusion to be a predominant restrictive measure. In contrast to many surrounding countries, Dutch legislation is arranged in such a way that the protection of the physical integrity of the patient is more important than professional considerations with respect to the treatment of severe mental illness. The opening of a new admission ward provided the opportunity to study the effect of a number of preventive measures both before and after admission on the use of seclusion. Two admission wards with the approximately the same staff compilation, the same admission criteria, and a comparable catchment area were followed for 29 months. In the experimental ward, a project was started with the aim to abandon seclusion in three years while, at the same time, reducing all other forms of restrain; the comparable ward had care as usual. The data show a decrease of number and duration of seclusion in the experimental ward in comparison to the ward providing care as usual. This difference could be related to a number of patient and ward characteristics.