School of Clinical Sciences, Auckland University of Technology, and Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.
Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia.
Int J Ment Health Nurs. 2017 Oct;26(5):491-499. doi: 10.1111/inm.12383.
Seclusion and mechanical restraint are restrictive interventions that should be used only as a last resort and for the shortest possible time, yet little is known about duration of use in the broader context. Adult area mental health services throughout Victoria, Australia, were asked to complete a report form for prolonged episodes of seclusion (>8 hours) and mechanical restraint (>1 hour). The present, retrospective cohort study aimed to understand the individual (age, sex, type of service, duration of intervention) and contextual factors associated with prolonged use of restrictive interventions. Contextual factors describing the reasons for prolonged use of the restrictive interventions were captured qualitatively, and then coded using content analysis. Median duration was compared across individual factors using Mann-Whitney U-tests. During 2014, 690 episodes of prolonged restrictive intervention involving 311 consumers were reported. Close to half (n = 320, 46%) involved mechanical restraint. Seclusion episodes (n = 370) were longer in forensic mental health services compared to adult area mental health services (median: 24 hours and 18 min vs 16 hours and 42 min, P < 0.001). Mechanical restraint episodes (n = 320) were shorter in forensic mental health services compared to adult area mental health services (median: 3 hours and 25 min vs 4 hours and 15 min, P = 0.008). Some consumers were subject to multiple episodes of prolonged seclusion (55/206, 27%) and/or prolonged mechanical restraint (31/131, 24%). The most commonly occurring contextual factor for prolonged restrictive interventions was 'risk of harm to others'. Means for reducing the use of prolonged restrictive interventions are discussed in light of the findings.
隔离和机械约束是限制干预措施，应仅作为最后的手段，并尽可能缩短使用时间，但在更广泛的背景下，对其使用时间知之甚少。澳大利亚维多利亚州的成人区域心理健康服务机构被要求为长时间的隔离（>8 小时）和机械约束（>1 小时）事件填写报告表。本回顾性队列研究旨在了解与限制干预措施长时间使用相关的个体（年龄、性别、服务类型、干预持续时间）和环境因素。使用内容分析法，对描述限制干预措施长时间使用原因的环境因素进行定性捕获并进行编码。使用 Mann-Whitney U 检验比较个体因素的中位数持续时间。在 2014 年，报告了 690 例涉及 311 名消费者的长时间限制干预事件。近一半（n=320，46%）涉及机械约束。与成人区域心理健康服务相比，法医心理健康服务中的隔离事件（n=370）时间更长（中位数：24 小时 18 分钟与 16 小时 42 分钟，P<0.001）。与成人区域心理健康服务相比，法医心理健康服务中的机械约束事件（n=320）时间更短（中位数：3 小时 25 分钟与 4 小时 15 分钟，P=0.008）。一些消费者经历了多次长时间的隔离（55/206，27%）和/或长时间的机械约束（31/131，24%）。长时间限制干预的最常见环境因素是“对他人造成伤害的风险”。根据研究结果，讨论了减少长时间限制干预措施使用的方法。
