Chakkera Shankar, Sieg Julia, Khofi Theodora, Ayieko Rosemina, Knettel Brandon A
Johns Hopkins University, Baltimore, MD, USA.
Faculty of Behavioural and Cultural Studies, Heidelberg University, Heidelberg, Germany.
Glob Ment Health (Camb). 2025 Sep 19;12:e99. doi: 10.1017/gmh.2025.10052. eCollection 2025.
More than 116 million people in Africa live with mental health conditions. However, many African countries lack the infrastructure, training and workforce to effectively manage psychiatric emergencies. This has led to overuse of controversial practices such as physical and chemical restraint and involuntary seclusion, often violating patient rights. We conducted a scoping review of restraint and seclusion practices and their impacts in African clinical settings using the PubMed, Embase, CINAHL, PsycInfo and ProQuest databases. Titles/abstracts and full texts were reviewed for inclusion using the Covidence platform, and 29 studies were included in the final extraction. Restraint and/or seclusion were employed to manage aggression, enable involuntary treatment or prevent self-harm. Patients found restraint and seclusion to be dehumanizing, a cause of posttraumatic stress and a barrier to future help-seeking. Healthcare workers described inadequate training, overuse of restraint and seclusion, injuries and emotional distress after employing these treatments. Further research, intervention development and policy reform are urgently needed to promote humane and patient-centered psychiatric care, including verbal de-escalation training, in underresourced healthcare systems.
非洲有超过1.16亿人患有精神健康问题。然而，许多非洲国家缺乏有效管理精神科急诊的基础设施、培训和工作人员。这导致了诸如身体和化学约束以及非自愿隔离等有争议做法的过度使用，常常侵犯患者权利。我们使用PubMed、Embase、CINAHL、PsycInfo和ProQuest数据库，对非洲临床环境中的约束和隔离做法及其影响进行了一项范围综述。使用Covidence平台对标题/摘要和全文进行筛选以确定是否纳入，最终提取纳入了29项研究。约束和/或隔离被用于管理攻击行为、实施非自愿治疗或防止自我伤害。患者认为约束和隔离有辱人格，是创伤后应激障碍的一个原因，也是未来寻求帮助的障碍。医护人员描述了培训不足、约束和隔离的过度使用、使用这些治疗方法后的伤害和情绪困扰。在资源不足的医疗系统中，迫切需要进一步的研究、干预措施开发和政策改革，以促进人道和以患者为中心的精神科护理，包括言语缓和训练。
