Restraint and seclusion: service user views
| Published date | 01 February 2002 |
| Date | 01 February 2002 |
| DOI | https://doi.org/10.1108/14668203200200003 |
| Pages | 15-24 |
| Author | Heather Sequeira,Simon Halstead |
| Subject Matter | Health & social care,Sociology |
key words
learning disabilities
mental health
service user views
restraint
seclusion
literature review
abstract
Despite the controversy
surrounding physical restraint and
seclusion in the care of vulnerable
adults, the views of service users
have had little impact on current
practice.This paper reviews the
literature documenting the personal
views and experience of people with
learning disabilities and severe
mental health problems following
these procedures.
The Journal of Adult Protection Volume 4 Issue 1 • February 2002 © Pavilion Publishing (Brighton) Limited 15
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Researchpaper
Introduction
Physical restraint and seclusion are usually justified as being
in the best interests of the service user (for example, Harris,
1996), but service users have had very little say in this. Little
hard evidence exists about the risks and benefits of physical
interventions for either people with learning disabilities or
those with severe mental health problems.
In a review of the mental health literature, Busch & Shore
(2000) concluded that there is insufficient evidence to guide
clinical practice in the relative risks and benefits of seclusion
and restraint. Similarly, in a Cochrane review Salias and
Fenton (2000) concluded that no controlled studies exist that
evaluate the value of seclusion and restraint.
Controversy as to the use of physical interventions is
intensified by reports of serious adverse effects such as
thrombosis and death (Lazarus, 2001; Hem, Steen &
Opjordsmoen, 2001; Morrison & Sadler, 2001). Other
descriptive reports have identified organisational difficulties
such as consumption of staff resources and diversion of staff
from therapeutic activities (Way & Banks, 1990) and the
potential for abuse of these procedures (Baker & Allen, 2001).
Despite this controversy, there is at least a limited consensus
among clinicians that such interventions are required. In a
recent paper, the Expert Consensus Panel for Behavioural
Emergencies (Allen et al, 2001) reported that 47% of experts
agreed that such interventions were necessary for one to five
per cent of patients seen in their services, while 32% reported
that they were necessary for six to 20% of patients.
Restraint and seclusion are debatably the most restrictive
Restraint and seclusion:
service user views
Heather Sequeira
Clinical Research Fellow, Department of
Psychiatry and Disability, St George’s Medical
School, London
Supported by St. Andrews Hospital,
Northampton
Simon Halstead
Medical Director, Care Principles Limited:
Ashley House, Staffordshire
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