Introduction
This literature review is focusing on discussing the effects of seclusion and restraints on treatment consequences of patients in mental health area. Seclusion and Restraint are used for controlling the behavioral patterns of the mentally ill patients in different surroundings consisting of psychiatric management facilities and hospitals (Kentley, 2009). Over past decade, comprehensible consensus has come out that seclusion and restraints are secure interventions of last alternative and application of those interventions should and can be diminished significantly (Knight, 2011). However, recent studies indicated that it is traumatic for patients experiencing or witnessing restraint and seclusion traumatic; patients can feel high levels of anxiety, fear, and anger once aware that restraint is going to take place, sometimes it could resulting in an exacerbation of patient’s mental status (Stewart et al, 2010). Due to the humanitarian, ethical, and legal issues which could lead to, seclusion and restraints are known as the most controversial management strategies (Holmes, Kennedy & Perron, 2004). Previous studies and researches could not analyze this topic adequately; thus, further researches and studies related to the effects and risk managements of using seclusions and restrains will be discussed in below.
Methodology
A number of different methods were applied in order to gather articles for this review. To narrow the search focus and to avoid vague information relevant nursing journals; mental health related publications; articles on seclusion and restraints effects on treatment outcomes were analyzed for availability and appropriateness of articles. The secondary research was further restricted to 2004 and newer...
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...y of international trends. Social psychiatry and psychiatric epidemiology , 45 (9), 889 - 897.
Stewart, D., Merwe, M. V., Bower, L., Simpson, A., & Jones, J. (2010). A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients. Informa healthcare, 31 (6), 413-424. doi:10.3109/01612840903484113
Symonds, J., & Huckshorn, K. A. (2004). SECLUSION & RESTRAINT Q&A/Response. Journal of Psychosocial Nursing & Mental Health Services , 42 (12), 8.
U.S. Department of Education. (2010). SECLUSION AND RESTRAINT STATUTES, REGULATIONS, POLICIES,AND GUIDANCE, BY STATE AND TERRITORY.
Sande, R. V., Noorthoorn, E., Wierdsma, A., Hellendoorn. E., Staak, C. V., & Mulder, C. L. (2013). Association between short-term structured risk assessment outcomes and seclusion. International journal of mental health nursing , 22 (6), 475 – 484.
Yet, solitary confinement is still considered necessary in order to maintain control within the prison and among inmates. Solitary confinement is seen as an effective method in protecting specific prisoners and altering violent/aggressive disobedient behaviors, (Maria A. Luise, Solitary Confinement: Legal and Psychological Considerations, 15 New Eng. J. on Crim. & Civ. Confinement 301, 324 (1989) p. 301). There is some discrepancy among researchers as to the varying effects on inmates who have undergone an extensive solitary confinement stay. Most researchers find that inmates who had no previous form of mental illness suffer far less than those who do, yet most if not all of these individuals still experience some difficulties with concentration and memory, agitation, irritability, and will have issues tolerating external stimuli, (Stuart Grassian, Psychiatric Effects of Solitary Confinement, 22 Wash. U. J. L. & Pol’y 325 (2006) p. 332). Although these detrimental psychiatric repercussions of solitary confinement currently appear, several researches have made suggestions as to how these may be avoided. These requirements being that
Griest, Stephanie Elizondo. “The Torture of Solitary.” Wilson Quarterly. Spring 2012: 22-29. SIRS Issues Researcher. Web. 13 Jan. 2014.
Physical restraint, according to Health Care Financing Administration, can be defined as any handling, physical and mechanical methods applied to a patient with the aim of denying him or her the freedom of movement or access to his or her own body (Di Lorenzo et al., 2011). It may involve use of belts or ties that restrain movement of an individual such as seclusion. Seclusion refers to isolation from others, often done in a room that’s I avoid of any furniture and has a small observable window as the only connection to the outside world (Chandler, 2012). The use of physical restraint in handling patients has been on debate for several years now. In most countries such Italy, it
Metzner, J. L., & Fellner, J. (2010). Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics. The Journal of the American Academy of Psychiatry and the Law, 38(1), 104-108.
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The study continues on to explain further ramifications, such as, physical effects. This shows some of the devastating effects the practice of administrative segregation has on inmates’ mental and physical well-being. Often, it is the mentally ill that are unfairly subject to this practice. “Mentally ill inmates may find themselves inappropriately placed in administrative segregation because of a lack of other suitable placements, protective custody reasons, or disruptive behavior related to their mental illness.” (O 'Keefe 125). Instead of providing safety to inmates and staff as the prison system claims administrative segregation is for, its main objective is social isolation. Which is one of the harmful elements of AS that makes it torture. Additionally, an annual report from the Canadian Government’s Office of the Correctional Investigator’s states, “close to one-third of reported self-injury incidents occurred in (federal prisons) segregation units”. Therefore, one can infer that the negative effects of AS are contradictory to providing safety to inmates. UN Special Rapporteur on Torture Juan Mendéz proposed administrative segregation should be banned as the “isolation of inmates amounted to cruel, inhuman or degrading treatment or punishment or – in more severe cases – to torture.” The ramifications of administrative segregation amount to what is defined as torture by lawyer and human rights Juan Mendéz. Administrative segregation is an unconstitutional treatment of inmates and does not constitute the values of our society, or the dignity and humanity of all people. Which is contradictory to rehabilitating a person to be physically, socially and mentally restored for reintroduction into society. Its use in Canada’s prison system is unjustified, unethical, and ultimately,
U.S. Public Health Service.(1999). The Surgeon General’s Report on Mental Health. Retrieved June 5, 2000, from http://www.surgeongeneral.gov/library/mentalhealth/home.html. Veroff,J.,Douvan,E.,& Kulka,R.A.(1981).
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The effects of prolonged isolation for inmates in confinement cells are obsessive-compulsive tendencies, paranoia, anger-management issues, and severe anxiety (Sifferlin, Alexandra). Along with the basic concepts such as food, water, and shelter, there are two other basics that Dr. Terry Kupers states are required for human wellbeing: “social interaction and meaningful activity. By doing things we learn who we are and we learn our worth as a person. The two things solitary confinement does are make people solitary and idle” (Sifferlin, Alexandra). Isolation and confinement remove prisoners’ ability to perform significant tasks and act as a part of society. This dehumanizes the inmates because they are no longer able to understand their role as a human being. One inmate, Jeanne DiMola, spent a year in solitary confinement and expressed her thoughts while in the cell: “I felt sorry I was born … Most of all I felt sorry that there wasn 't a road to kill myself because every day was worse than the last" (Rodhan, Maya). In DiMola’s opinion, a death penalty more than likely would have felt more humane than the isolation she experienced. Another prisoner, Damon Thibodeaux, stated, “Life in solitary is made all the worse because it 's a hopeless existence … It is torture
Thousands of people statewide are in prisons, all for different reasons. However, the amount of mental illness within prisons seems to go unaddressed and ignored throughout the country. This is a serious problem, and the therapy/rehabilitation that prison systems have do not always help those who are mentally ill. Prison involvement itself can contribute to increased suicide (Hills, Holly). One ‘therapy’ that has increased throughout the years has been the use of solitary confinement, which has many negative effects on the inmates.
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In 2001, over 450 million people worldwide suffered from mental illness (World Health Organisation, 2001) and these numbers have increased by a wide margin since then. Using restraints in treatment for those who are mentally ill is a topic that creates a large amount of controversy. Many are concerned with how the use of restraints can affect the person and if they are necessary or if alternative measures could be used. The National Alliance of Mental Illness has indicated their position on restraints, “The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to a patient or others.” (The National Alliance of Mental Illness, 2001) There have
Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
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