Seclusion and restraint in psychiatry: Patients' experiences and practical suggestions on how to improve practices and use alternatives

Perspectives in Psychiatric Care

Volumn 48, Issue 1, 2012, Pages 16-24

  Kontio, Raija ^a,b   Joffe, Grigori ^c   Putkonen, Hanna ^d   Kuosmanen, Lauri ^a,e   Hane, Kimmo ^a,b   Holi, Matti ^c   Välimäki, Maritta ^a,f  

^a UNIVERSITY OF TURKU   (Finland)

^b HYVINKÄÄ HOSPITAL   (Finland)

^c HELSINKI UNIVERSITY CENTRAL HOSPITAL   (Finland)

^d VANHA VAASA HOSPITAL   (Finland)

^e City of Vantaa   (Finland)

^f HOSPITAL DISTRICT OF SOUTHWEST FINLAND   (Finland)

Author keywords

Alternative method; Inductive content analysis; Psychiatric inpatient; Psychiatry; Restraint; Seclusion

Indexed keywords

ADULT; ARTICLE; EXERCISE; FEMALE; FINLAND; HOSPITAL PATIENT; HUMAN; MALE; MENTAL DISEASE; MIDDLE AGED; NURSING; PATIENT PARTICIPATION; PSYCHIATRIC DEPARTMENT; PSYCHOLOGICAL ASPECT; SOCIAL ISOLATION; STANDARD;

ADULT; FEMALE; FINLAND; HUMANS; INPATIENTS; MALE; MENTAL DISORDERS; MIDDLE AGED; PATIENT PARTICIPATION; PSYCHIATRIC DEPARTMENT, HOSPITAL; RESTRAINT, PHYSICAL; SOCIAL ISOLATION;

EID: 84255201106     PISSN: 00315990     EISSN: 17446163     Source Type: Journal    
DOI: 10.1111/j.1744-6163.2010.00301.x     Document Type: Article

References (38)

1. Amendment to the Mental Health Act, 1423/2001. (2001). Edita Publishing Oy. (2007, November 14). Retrieved from
2. Burns, N., & Grove, S. (2005). Understanding nursing research (3rd ed.). Philadelphia: W.B. Saunders.
3. Council of Europe. (2000). White paper on the protection of the human rights and dignity of people suffering from mental disorder, especially those placed as involuntary patients in a psychiatric establishment. (2008, October 28). Retrieved from
4. European Charter of Patients' Rights. (2002). Basic document. Rome, November 2002. (2006, November 14). Retrieved from
5. European Commission. (2005). Green paper. Improving the mental health of the population: Towards a strategy on mental health for the European Union. Health and Consumer Protection. Directorate-General. Brussels, 14.10.2005, COM (2005) 484. Brussels.
6. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. (2009). Report to the Finnish government on the visit to Finland. CPT/Inf (2009) 5. Council of Europe, Strasbourgh, 20 January 2009.
7. Foster, C., Bowers, L., & Nijman, H. (2007). Aggressive behaviour on acute psychiatric wards: Prevalence, severity and management. Journal of Advanced Nursing, 58(2), 140-149. doi:10.1111/j.1365-2648.2007.04169.x
8. Frueh, B., Knapp, R., Cusack, K., Grubaugh, A., Sauvageot, J., Cousins, V.... Hiers, T. (2005). Patients' report of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services, 56(9), 1123-1133. doi:10.1176/appi.ps.56.9.1123
9. Gaskin, C., Elsom, S., & Happell, B. (2007). Interventions for reducing the use of seclusion in psychiatric facilities. Review of the literature. British Journal of Psychiatry, 191, 298-303. doi:10.1192/bjp.bp.106.034538
10. Hansson, L. (1989). Patient satisfaction with in-hospital psychiatric care. A study of a 1-year population of patients hospitalized in a sectorized care organization. European Archives of Psychiatry and Neurological Sciences, 239(2), 93-100. doi:10.1007/BF01759581
11. Happell, B., & Harrow, A. (2010). Nurses' attitudes to the use of seclusion: A review of the literature. International Journal of Mental Health Nursing, 19(3), 162-168. doi:10.1111/j.1447-0349.2010.00669.x
12. Happell, B., & Koehn, S. (2010). From numbers to understanding: The impact of demographic factors on seclusion rates. International Journal of Mental Health Nursing, 19(3), 169-176. doi:10.1111/j.1447-0349.2010.00670.x
13. Hätönen, H., Kuosmanen, L., Koivunen, M., & Välimäki, M. (2010). Patient education practices in psychiatric hospital wards: A national survey in Finland. Nordic Journal of Psychiatry, 64, 334-339. doi:10.3109/08039481003675076
14. Hoekstra, T., Lendemeijer, H., & Jansen, M. (2004). Seclusion: The inside story. Journal of Psychiatric and Mental Health Nursing, 11(3), 276-283. doi:10.1111/j.1365-2850.2003.00710.x
15. Holmes, D., Kennedy, S. L., & Perron, A. (2004). The mentally ill and social exclusion: A critical examination of the use of seclusion from the patient's perspective. Issues in Mental Health Nursing, 25(6), 559-578. doi:10.1080/01612840490472101
16. Howard, P. B., El-Mallakh, P., Kay Rayens, M., & Clark, J. (2003). Consumer perspectives on quality of inpatient mental health services. Archives of Psychiatric Nursing, 17(5), 205-217. doi:10.1016/S0883-9417(03)00096-7
17. Huckshorn, K. (2004). Reducing seclusion, restraint in mental health use settings: Core strategies for prevention. Journal of Psychosocial Nursing in Mental Health Services, 42(9), 22-33.
18. Hyde, S., Fulbrook, P., Fenton, K., & Kilshaw, M. (2009). A clinical improvement project to develop and implement a decision-making framework for the use of seclusion. International Journal of Mental Health Nursing, 18(6), 398-408. doi:10.1111/j.1447-0349.2009.00631.x
19. International Council of Nurses. (2006). Code of ethics for nurses (pp. 1-12). Geneva: Author. (2009, November 20). Retrieved from
20. Jenkins, K., Bennett, L., Lancaster, L., O'Donoghue, D., & Carillo, F. (2002). Improving the nurse-patient relationship: A multi-faceted approach. EDTNA/ERCA Journal, 28(3), 145-150.
21. Keski-Valkama, A., Koivisto, A.-M., Eronen, M., & Kaltiala-Heino, R. (2010). Forensic and general psychiatric patients' views of seclusion: A comparison study. Journal of Forensic Psychiatry & Psychology, 21(3), 446-461. doi:10.1080/14789940903456569
22. Keski-Valkama, A., Sailas, E., Eronen, M., Koivisto, A.-M., Lönnqvist, J., & Kaltiala-Heino, R. (2007). A 15-year national follow-up: Legislation is not enough to reduce the use of seclusion and restraint. Social Psychiatry and Psychiatric Epidemiology, 42(9), 747-752. doi:10.1007/s00127-007-0219-7
23. Keski-Valkama, A., Sailas, E., Eronen, M., Koivisto, A.-M., Lönnqvist, J., & Kaltiala-Heino, R. (2009). Who are the restrained and secluded patients: A 15-year nationwide study. Social Psychiatry and Psychiatric Epidemiology, 45, 1087-1093. doi:10.1007/s00127-009-0150-1
24. Kjellin, L., Andersson, K., Bartholdson, E., Candefjord, I. L., Holmström, H., Jacobsson, L.... Östman, M. (2004). Coercion in psychiatric care-Patients' and relatives' experiences from four Swedish psychiatric services. Nordic Journal of Psychiatry, 58(2), 153-159. doi:10.1080/08039480410005549
25. Kuosmanen, L., Hätönen, H., Jyrkinen, A. R., Katajisto, J., & Välimäki, M. (2006). Patient satisfaction with psychiatric inpatient care. Journal of Advanced Nursing, 55(6), 655-663. doi:10.1111/j.1365-2648.2006.03957.x
26. Kuosmanen, L., Hätönen, H., Malkavaara, H., Kylmä, J., & Välimäki, M. (2007). Deprivation of liberty in psychiatric hospital care: The patient's perspective. Nursing Ethics, 14(5), 597-607. doi:10.1177/0969733007080205
27. Meehan, T., Bergen, H., & Fjeldsoe, K. (2004). Staff and patient perceptions of seclusion: Has anything changed? Journal of Advanced Nursing, 47(1), 33-38. doi:10.1111/j.1365-2648.2004.03062.x
28. Meehan, T., Vermeer, C., & Windsor, C. (2000). Patients' perceptions of seclusion: A qualitative investigation. Journal of Advanced Nursing, 31(2), 370-377. doi:10.1046/j.1365-2648.2000.01289.x
29. Ministry of Social Affairs and Health. (2009). Plan for mental health and substance abuse work. Proposals of the Mieli 2009 working group to develop mental health and substance abuse work until 2015. Reports of the Ministry of Social Affairs and Health, 2009: 3.
30. Müller, M. J., Schlösser, R., Kapp-Steen, G., Schanz, B., & Benkert, O. (2002). Patients' satisfaction with psychiatric treatment: Comparison between an open and a closed ward. Psychiatric Quarterly, 73(2), 93-107. doi:10.1023/A:1015099526445
31. Muraliharan, S., & Fenton, M. (2006). Containment strategies for people with serious mental illness. Cochrane Database of Systematic Reviews, (3), CD002084. doi:10.1002/14651858. CD002084.pub2
32. Olofsson, B., & Nordberg, A. (2001). Experiences of coercion in psychiatric care as narrated by patients, nurses and physicians. Journal of Advanced Nursing, 33(1), 89-97.
33. Ryan, R., & Happell, B. (2009). Learning from experience: Using action research to discover consumer needs in post-seclusion debriefing. International Journal of Mental Health Nursing, 18(2), 100-107. doi:10.1111/j.1447-0349.2008.00579.x
34. Sailas, E., & Fenton, M. (2000). Seclusion and restraint for people with serious mental illness. Cochrane Database Systematic Reviews, (1), CD001163. doi:10.1002/14651858. CD001163
35. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357. doi:10.1093/intqhc/mzm042
36. Whittington, R., Bowers, L., Nolan, P., Simpson, A., & Lindsay, N. (2009). Approval ratings of inpatient coercive interventions in a national sample of mental health service users and staff in England. Psychiatric Services, 60(6), 792-798. doi:10.1176/appi.ps.60.6.792
37. Wright, S. (2003). Control and restraint techniques in the management of violence in inpatient psychiatry: A critical review. Medical Science Law, 43(1), 31-38. doi:10.1258/rsmmsl.43.1.31
38. Wynaden, D., Chapman, R., McGowan, S., Holmes, C., Ash, P., & Boschman, A. (2002). Through the eye of the beholder: To seclude or not to seclude. International Journal of Mental Health Nursing, 11(4), 260-268. doi:10.1046/j.1440-0979.2002.00257.x