Efforts to reduce seclusion and restraint use in a state psychiatric hospital: A ten-year perspective

Objective: The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time. Methods: This follow-up study examined archival data by using a longer preintervention baseline phase and examined the sustainability of intervention gains in the absence of a research agenda. Over ten years, 3,040 seclusion and restraint incidents were analyzed across 254,491 patient-days. Results: The extended baseline phase (N=38 months) exhibited a linear trend upward in seclusion and restraint use, and the formal intervention period and subsequent follow-up periods (N=82 months) showed a stabilization effect (p<.001). Conclusions: The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice - even in the face of potentially disruptive administrative and environmental changes.