The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Brenda Happell - One of the best experts on this subject based on the ideXlab platform.
-
the relationships between attitudes toward Seclusion and levels of burnout staff satisfaction and therapeutic optimism in a district health service
Issues in Mental Health Nursing, 2012Co-Authors: Brenda Happell, Gerry Dares, Alistair Russell, Siobhan Cokell, Chris Plataniaphung, Cadeyrn J GaskinAbstract:The main purpose of this study was to investigate the relationships between attitudes toward Seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Staff at one district health service inpatient unit (n = 54) completed surveys on their attitudes toward Seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Several moderately large correlations were found between perceiving the patients as feeling punished by Seclusion and intrinsic satisfaction (rs = –.45, p = .001), and between patients asking to go to the Seclusion room and personal accomplishment (rs = –.39, p = .002). In general, however, most correlations were small or negligible in size. The influence of nurses on the practice of Seclusion was clear, with 72% of participants indicating it was nurses who most often make decisions regarding Seclusion. Some participants appear to have a broad interpretation of when Seclusion should be used, raising doubts about whether it is being employed solely as a mea...
-
exploring patterns of Seclusion use in australian mental health services
Archives of Psychiatric Nursing, 2011Co-Authors: Brenda Happell, Cadeyrn J GaskinAbstract:Seclusion has remained a common practice in mental health services. In Australia, recent mental health policy has reflected a desire to reduce (and, if possible, eliminate) the use of Seclusion. The collection and analysis of data on the use of Seclusion have been identified as an important component of the success of reduction initiatives. A cross-sectional design was used in the collection of inpatient unit data on Seclusions that occurred in 11 mental health services in Australia over a 6-month period. During this time, there were 4,337 episodes of care. One or more Seclusions occurred in 6.8% of episodes of care, with consumers being secluded, on average, 2.32 times and with 44% of them having been secluded more than once. The average length of the Seclusions was 2 hours 52 minutes, with 51.4% of Seclusions being less than 2 hours. These rates were lower than those reported in previous research studies. The practice of Seclusion occurred more commonly on the first 2 days following admission, on weekdays than weekends, and between the hours of 9:00 a.m. and midnight. An understanding of Seclusion data can provide fundamental information from which strategies to reduce Seclusion can be developed.
-
Seclusion as a necessary intervention: the relationship between burnout, job satisfaction and therapeutic optimism and justification for the use of Seclusion.
Journal of advanced nursing, 2011Co-Authors: Brenda Happell, Stefan KoehnAbstract:happell b. & koehn s. (2011) Seclusion as a necessary intervention: the relationship between burnout, job satisfaction and therapeutic optimism and justification for the use of Seclusion. Journal of Advanced Nursing67(6), 1222–1231. Abstract Aims. This paper is a report of the study of nurses’ attitudes to the use of Seclusion. More specifically, the aim was to address the relationship between burnout, job satisfaction and therapeutic optimism and justification of the use of Seclusion. Background. Research findings demonstrate that nurses continue to view Seclusion as a necessary intervention. Factors that might be associated with attitudes have not been examined. Methods. Questionnaires were distributed to nurses employed in inpatient units across eight mental health services in Queensland in 2008. Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach’s Burnout Inventory and Minnesota Satisfaction Questionnaires were completed (N = 123). Data analysis involved descriptive statistics and Pearson product-moment correlation coefficients. Results. Most participants considered certain behaviours particularly those involving harm to self, others or to property as appropriate reasons for the use of Seclusion and were consistent with their perceptions of the likely practice on their unit. An association was found between therapeutic optimism and emotional exhaustion (burnout) and justifications for the use of Seclusion. Participants with higher optimism scores and lower scores for emotional exhaustion were significantly less likely to support the use of Seclusion in specific situations. Conclusions. The relationship between therapeutic optimism and emotional exhaustion gives new information that might influence strategies and approaches taken with the aim of reducing Seclusion use. Further research is warranted to explore these relationships and their implications.
-
Impacts of Seclusion and the Seclusion room: exploring the perceptions of mental health nurses in Australia.
Archives of psychiatric nursing, 2011Co-Authors: Brenda Happell, Stefan KoehnAbstract:The practice of Seclusion does not sit comfortably with contemporary Australian mental health policy that emphasizes the provision of mental health services in the least restrictive environment. The negative impact of Seclusion on patients and nurses is increasingly being acknowledged. On the other hand, Seclusion receives wide support from nurses as a necessary behavior management strategy. The aim of this study was to examine nurses' perceptions of the impact of Seclusion and the Seclusion room on patients and the changes they would consider to the Seclusion room in relation to characteristics of the nurses, including therapeutic optimism, job satisfaction, and burnout. One hundred twenty-three nurses employed in mental health services from Queensland, Australia, participated in this study by completing four self-report scales to measure these attitudes and characteristics. Data were analyzed using descriptive statistics and Pearson's product-moment correlation coefficients. The findings indicate some relationship between the three scales and attitudes to Seclusion; however, therapeutic optimism had the strongest link. Participants with higher scores for optimism were more likely to acknowledge the detrimental effects of Seclusion and the Seclusion room and were more likely to support positive changes to the Seclusion room.
-
Nurses' attitudes to the use of Seclusion: a review of the literature.
International journal of mental health nursing, 2010Co-Authors: Brenda Happell, Alison HarrowAbstract:Seclusion is now widely recognized as a coercive strategy with negative consequences for the consumers and staff involved. Nevertheless, this intervention continues to be used frequently in mental health services internationally. Due to their direct care role, nurses are commonly involved in the initiation or management of Seclusion. Understanding nurses' attitudes to Seclusion is therefore essential for the success of any attempts to reduce its use. A review of the literature was conducted using the search terms 'patient', 'Seclusion', 'attitudes', 'nurses' and 'containment'. Twenty-eight articles which met the inclusion criteria were identified. Analysis of these articles identified six main themes: a necessary intervention; workplace culture; staff composition and experience; conflict; ethical considerations; and consumer characteristics. An overview of the literature is presented according to these main themes. The research suggests that most nurses support the continued use of Seclusion as a strategy for the management of violence and aggression. A deeper understanding of the factors that influence attitudes is necessary if Seclusion rates are to be effectively reduced.
H L I Nijman - One of the best experts on this subject based on the ideXlab platform.
-
differences in Seclusion rates between admission wards does patient compilation explain
Psychiatric Quarterly, 2013Co-Authors: W A Janssen, E O Noorthoorn, H L I Nijman, Len Bowers, Adriaan W Hoogendoorn, A Smit, Guy WiddershovenAbstract:Comparison of Seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and duration of Seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences in patient characteristics, as these are expected to have a large impact on these Seclusion rates. Nurses assume more admissions of severely ill patients are related to higher Seclusion rates. In order to test this hypothesis, we investigated differences in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and ward characteristics and the wards' number of Seclusion hours per 1,000 admission hours. In a multivariate and a multilevel analysis, various characteristics turned out to be related to the number of Seclusion hours per 1,000 admission hours as well as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that Seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences in Seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest deal of the difference between wards in Seclusion rates could not be explained by characteristics measured in this study. We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of Seclusion.
-
the effects of a nationwide program to reduce Seclusion in the netherlands
BMC Psychiatry, 2012Co-Authors: Fleur J Vruwink, Cornelis L Mulder, E O Noorthoorn, Daan Uitenbroek, H L I NijmanAbstract:Background: From 2006 to 2009, the Dutch government provided €5 m annually for a nationwide program to reduce Seclusion in psychiatric hospitals by 10% a year. We aimed to establish whether the numbers of both Seclusion and involuntary medication changed significantly after the start of this national program. Methods: Using Poisson regression to estimate difference in logit slopes, we analyzed data for 1998–2009 from the Dutch Health Care Inspectorate, retrospectively examining the national numbers of Seclusion and involuntary medication before and after the start of the program. Results: The difference in slopes of the numbers of Seclusion before and after the start of the program was statistically significant (difference 5.2%: p < 0.001). After the start of the program Seclusions dropped 2.0% per year. Corrected for the increasing number of involuntary hospitalizations this figure was 4.7% per year. The difference in slopes of the numbers of involuntary medication did not change statistically significant (difference 0.5%, n.s.). After correction for the increasing number of involuntary hospitalizations the difference turned significant (difference 3.3%, p = 0.002). Conclusions: After the start of the nationwide program the number of Seclusions fell, and although significantly changing, the reduction was modest and failed to meet the objective of a 10% annual decrease. The number of involuntary medications did not change; instead, after correction for the number of involuntary hospitalizations, it increased.
-
the scope for replacing Seclusion with time out in acute inpatient psychiatry in england
Journal of Advanced Nursing, 2012Co-Authors: Len Bowers, E O Noorthoorn, H L I Nijman, Eimear Muircochrane, Jamie Ross, Duncan StewartAbstract:Background. The use of Seclusion is unpalatable to nurses and frequently unpleasant for patients. Time out is rated by nurses and patients as more acceptable. Several countries have initiated exercises to reduce the use of Seclusion, but England has not. Methods. In this study, data were collected on the sequence of conflict (aggression, rule breaking, absconding etc.) and containment (coerced medication, restraint, special observation etc., including time out and Seclusion) for the first 2 weeks of 522 acute admissions on 84 wards in 31 English hospitals between June 2009 and March 2010. Data were analysed to describe what preceded and followed time out and Seclusion episodes in a nursing shift. Results. Seclusion was used with 7AE5% of patients, and time out with 15AE5%. Both containment methods were used with similar patients in similar circumstances, and both brought disturbed behaviour to a close in half of the cases. Some Seclusion appeared to follow less serious disturbed behaviour. There was an important variation in rates of Seclusion between hospitals. Seclusion and time out had equally good outcomes in the management of physical violence to others. Conclusions. There is good evidence that Seclusion rates can be reduced safely, and time out can sometimes be used as a substitute. A national registration and reporting system should be introduced in England, and serious efforts made to reduce Seclusion use in hospitals where rates are high.
-
aggression and Seclusion on acute psychiatric wards effect of short term risk assessment
British Journal of Psychiatry, 2011Co-Authors: R R W Van De Sande, E O Noorthoorn, H L I Nijman, Andre I Wierdsma, E M Hellendoorn, C P F Van Der Staak, Cornelis L MulderAbstract:Background Short-term structured risk assessment is presumed to reduce incidents of aggression and Seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. Aims To evaluate the effect of risk assessment on the number of aggression incidents and time in Seclusion for patients admitted to acute psychiatric wards. Method A cluster randomised controlled trial was conducted in four wards over a 40-week period ( n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and Seclusion were compared with two control wards where assessment was based purely on clinical judgement. Results The numbers of aggressive incidents (relative risk reduction –68%, P <0.001) and of patients engaging in aggression (relative risk reduction RRR = –50%, P <0.05) and the time spent in Seclusion (RRR = –45%, P <0.05) were significantly lower in the experimental wards than in the control wards. Neither the number of Seclusions nor the number of patients exposed to Seclusion decreased. Conclusions Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and Seclusion in psychiatric wards.
-
Are Patients' Views on Seclusion Associated With Lack of Privacy in the Ward?
Archives of psychiatric nursing, 2006Co-Authors: J.j. Stolker, H L I Nijman, Piet-hein ZwanikkenAbstract:The lack of single-bed rooms in psychiatric wards may reduce the possibility of patients getting sufficient rest and privacy and may increase their risk of being overstimulated. This study explored whether residing in single- versus multiple-bed rooms in a psychiatric ward was associated with psychiatric patients' opinions about Seclusion. More specifically, it was studied whether patients who had shared a room with other patients prior to Seclusion rated Seclusion more favorably. It was thought that they would rate Seclusion more favorably due to the lack of rest they previously experienced in their regular room. For this, the Patient View-of-Seclusion Questionnaire of Hammill, McEvoy, Koral, and Schneider [Hammill, K., McEvoy, J., Koral, H., & Schneider, N. (1989). Hospitalized schizophrenic patient views about Seclusion. Journal of Clinical Psychiatry , 50, 174–177] was completed by 54 secluded adult patients hospitalized in a locked ward of a Dutch psychiatric hospital. A significant association was found between residing in multiple-bed rooms prior to Seclusion and a less negative view on Seclusion. This finding suggests that the ward environment may have a rather large impact on how Seclusion is perceived. The results underline the need for single-bed rooms in the treatment of psychiatric inpatients.
E O Noorthoorn - One of the best experts on this subject based on the ideXlab platform.
-
differences in Seclusion rates between admission wards does patient compilation explain
Psychiatric Quarterly, 2013Co-Authors: W A Janssen, E O Noorthoorn, H L I Nijman, Len Bowers, Adriaan W Hoogendoorn, A Smit, Guy WiddershovenAbstract:Comparison of Seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and duration of Seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences in patient characteristics, as these are expected to have a large impact on these Seclusion rates. Nurses assume more admissions of severely ill patients are related to higher Seclusion rates. In order to test this hypothesis, we investigated differences in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and ward characteristics and the wards' number of Seclusion hours per 1,000 admission hours. In a multivariate and a multilevel analysis, various characteristics turned out to be related to the number of Seclusion hours per 1,000 admission hours as well as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that Seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences in Seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest deal of the difference between wards in Seclusion rates could not be explained by characteristics measured in this study. We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of Seclusion.
-
reducing Seclusion through involuntary medication a randomized clinical trial
Psychiatry Research-neuroimaging, 2013Co-Authors: Irina Georgieva, Cornelis L Mulder, E O NoorthoornAbstract:Abstract Purpose The study evaluated whether Seclusion and coercive incidents would be reduced in extent and number if involuntary medication was the first choice of intervention. Patients admitted to an acute psychiatric ward were randomly allocated to two groups. In Group 1, involuntary medication was the intervention of first choice for dealing with agitation and risk of violence. In Group 2, Seclusion was the intervention of first choice. Patients' characteristics between the groups were compared by Pearson χ 2 and two-sample t -tests; the incidence rates and risk ratios (RRs) were calculated to examine differences in number and duration of coercive incidents. In Group 1, the relative risk of being secluded was lower than in Group 2, whereas the risk of receiving involuntary medication was higher. However, the mean duration of the Seclusion incidents did not differ significantly between the two groups; neither did the total number of coercive incidents. Although the use of involuntary medication could successfully replace and reduce the number of Seclusions, alternative interventions are needed to reduce the overall number and duration of coercive incidents. A new policy for managing acute aggression — such as involuntary medication — can be implemented effectively only if certain conditions are met.
-
the effects of a nationwide program to reduce Seclusion in the netherlands
BMC Psychiatry, 2012Co-Authors: Fleur J Vruwink, Cornelis L Mulder, E O Noorthoorn, Daan Uitenbroek, H L I NijmanAbstract:Background: From 2006 to 2009, the Dutch government provided €5 m annually for a nationwide program to reduce Seclusion in psychiatric hospitals by 10% a year. We aimed to establish whether the numbers of both Seclusion and involuntary medication changed significantly after the start of this national program. Methods: Using Poisson regression to estimate difference in logit slopes, we analyzed data for 1998–2009 from the Dutch Health Care Inspectorate, retrospectively examining the national numbers of Seclusion and involuntary medication before and after the start of the program. Results: The difference in slopes of the numbers of Seclusion before and after the start of the program was statistically significant (difference 5.2%: p < 0.001). After the start of the program Seclusions dropped 2.0% per year. Corrected for the increasing number of involuntary hospitalizations this figure was 4.7% per year. The difference in slopes of the numbers of involuntary medication did not change statistically significant (difference 0.5%, n.s.). After correction for the increasing number of involuntary hospitalizations the difference turned significant (difference 3.3%, p = 0.002). Conclusions: After the start of the nationwide program the number of Seclusions fell, and although significantly changing, the reduction was modest and failed to meet the objective of a 10% annual decrease. The number of involuntary medications did not change; instead, after correction for the number of involuntary hospitalizations, it increased.
-
the scope for replacing Seclusion with time out in acute inpatient psychiatry in england
Journal of Advanced Nursing, 2012Co-Authors: Len Bowers, E O Noorthoorn, H L I Nijman, Eimear Muircochrane, Jamie Ross, Duncan StewartAbstract:Background. The use of Seclusion is unpalatable to nurses and frequently unpleasant for patients. Time out is rated by nurses and patients as more acceptable. Several countries have initiated exercises to reduce the use of Seclusion, but England has not. Methods. In this study, data were collected on the sequence of conflict (aggression, rule breaking, absconding etc.) and containment (coerced medication, restraint, special observation etc., including time out and Seclusion) for the first 2 weeks of 522 acute admissions on 84 wards in 31 English hospitals between June 2009 and March 2010. Data were analysed to describe what preceded and followed time out and Seclusion episodes in a nursing shift. Results. Seclusion was used with 7AE5% of patients, and time out with 15AE5%. Both containment methods were used with similar patients in similar circumstances, and both brought disturbed behaviour to a close in half of the cases. Some Seclusion appeared to follow less serious disturbed behaviour. There was an important variation in rates of Seclusion between hospitals. Seclusion and time out had equally good outcomes in the management of physical violence to others. Conclusions. There is good evidence that Seclusion rates can be reduced safely, and time out can sometimes be used as a substitute. A national registration and reporting system should be introduced in England, and serious efforts made to reduce Seclusion use in hospitals where rates are high.
-
aggression and Seclusion on acute psychiatric wards effect of short term risk assessment
British Journal of Psychiatry, 2011Co-Authors: R R W Van De Sande, E O Noorthoorn, H L I Nijman, Andre I Wierdsma, E M Hellendoorn, C P F Van Der Staak, Cornelis L MulderAbstract:Background Short-term structured risk assessment is presumed to reduce incidents of aggression and Seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. Aims To evaluate the effect of risk assessment on the number of aggression incidents and time in Seclusion for patients admitted to acute psychiatric wards. Method A cluster randomised controlled trial was conducted in four wards over a 40-week period ( n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and Seclusion were compared with two control wards where assessment was based purely on clinical judgement. Results The numbers of aggressive incidents (relative risk reduction –68%, P <0.001) and of patients engaging in aggression (relative risk reduction RRR = –50%, P <0.05) and the time spent in Seclusion (RRR = –45%, P <0.05) were significantly lower in the experimental wards than in the control wards. Neither the number of Seclusions nor the number of patients exposed to Seclusion decreased. Conclusions Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and Seclusion in psychiatric wards.
Cadeyrn J Gaskin - One of the best experts on this subject based on the ideXlab platform.
-
the relationships between attitudes toward Seclusion and levels of burnout staff satisfaction and therapeutic optimism in a district health service
Issues in Mental Health Nursing, 2012Co-Authors: Brenda Happell, Gerry Dares, Alistair Russell, Siobhan Cokell, Chris Plataniaphung, Cadeyrn J GaskinAbstract:The main purpose of this study was to investigate the relationships between attitudes toward Seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Staff at one district health service inpatient unit (n = 54) completed surveys on their attitudes toward Seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Several moderately large correlations were found between perceiving the patients as feeling punished by Seclusion and intrinsic satisfaction (rs = –.45, p = .001), and between patients asking to go to the Seclusion room and personal accomplishment (rs = –.39, p = .002). In general, however, most correlations were small or negligible in size. The influence of nurses on the practice of Seclusion was clear, with 72% of participants indicating it was nurses who most often make decisions regarding Seclusion. Some participants appear to have a broad interpretation of when Seclusion should be used, raising doubts about whether it is being employed solely as a mea...
-
exploring patterns of Seclusion use in australian mental health services
Archives of Psychiatric Nursing, 2011Co-Authors: Brenda Happell, Cadeyrn J GaskinAbstract:Seclusion has remained a common practice in mental health services. In Australia, recent mental health policy has reflected a desire to reduce (and, if possible, eliminate) the use of Seclusion. The collection and analysis of data on the use of Seclusion have been identified as an important component of the success of reduction initiatives. A cross-sectional design was used in the collection of inpatient unit data on Seclusions that occurred in 11 mental health services in Australia over a 6-month period. During this time, there were 4,337 episodes of care. One or more Seclusions occurred in 6.8% of episodes of care, with consumers being secluded, on average, 2.32 times and with 44% of them having been secluded more than once. The average length of the Seclusions was 2 hours 52 minutes, with 51.4% of Seclusions being less than 2 hours. These rates were lower than those reported in previous research studies. The practice of Seclusion occurred more commonly on the first 2 days following admission, on weekdays than weekends, and between the hours of 9:00 a.m. and midnight. An understanding of Seclusion data can provide fundamental information from which strategies to reduce Seclusion can be developed.
-
interventions for reducing the use of Seclusion in psychiatric facilities review of the literature
British Journal of Psychiatry, 2007Co-Authors: Cadeyrn J Gaskin, Stephen Elsom, Brenda HappellAbstract:Background The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and Seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted. Aims To find empirically supported interventions that allow reduction in the use of Seclusion in psychiatric facilities. Method We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of Seclusion. Results Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring Seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in Seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare. Conclusions Reducing Seclusion rates is challenging andgenerally requires staff to implement several interventions.
Mrigendra Das - One of the best experts on this subject based on the ideXlab platform.
-
Innovation and pragmatism required to reduce Seclusion practices.
CNS spectrums, 2016Co-Authors: John Tully, Leo Mcsweeney, Katie Lynn Harfield, Cindie Castle, Mrigendra DasAbstract:Seclusion may be harmful and traumatic to patients, detrimental to therapeutic relationships, and can result in physical injury to staff. Further, strategies to reduce Seclusion have been identified as a potential method of improving cost-effectiveness of psychiatric services. However, developing alternative strategies to Seclusion can be difficult. Interventions to reduce Seclusion do not lend themselves to evaluation using randomized controlled trials (RCTs), though comprehensive literature reviews have demonstrated considerable non-RCT evidence for interventions to reduce Seclusion in psychiatric facilities. In the UK, a recent 5-year evaluation of Seclusion practice in a high secure UK hospital revealed reduced rates of Seclusion without an increase in adverse incidents. To assess the effect of a novel intervention strategy for reduction of long-term segregation on a high secure, high dependency forensic psychiatry ward in the UK, we introduced a pilot program involving stratified levels of Seclusion ("long-term segregation"), multidisciplinary feedback and information sharing, and a bespoke occupational therapy program. Reduced Seclusion was demonstrated and staff feedback was mainly positive, indicating increased dynamism and empowerment on the ward. A more structured, stratified approach to Seclusion, incorporating multidisciplinary team-working, senior administrative involvement, dynamic risk assessment, and bespoke occupational therapy may lead to a more effective model of reducing Seclusion in high secure hospitals and other psychiatric settings. While lacking an evidence base at the level of RCTs, innovative, pragmatic strategies are likely to have an impact at a clinical level and should guide future practice and research.
