Biomaterial Database

Mental health service users' perceptions and experiences of sedation, seclusion and restraint. 2010

Pat Mayers, and Nelleke Keet, and Gunter Winkler, and Alan J Flisher

Division of Nursing and Midwifery, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa. Pat.Mayers@uct.ac.za

BACKGROUND Sedation, seclusion or restraint are recognized methods of containing a person experiencing an acute psychotic episode with behavioural disturbance which has not responded to verbal or non-sedating pharmacological interventions. These interventions pose significant ethical and practical challenges to service providers who are responsible for safeguarding the human rights of mental health service users. OBJECTIVE In a collaborative two-phase study between mental health care providers and mental health service users, the perceptions and experiences of a group of service users who have been exposed to sedation, seclusion and restraint were explored. METHODS A focus group was conducted with eight service users. The content of the focus group was transcribed and themes were identified using thematic analysis. These were presented to a second focus group consisting of eight other service users for validation and comment. Based on the results of the focus groups, a questionnaire was developed and administered to a convenience sample of 43 service users in three localities. RESULTS Service users reported inadequate communication between them and service providers and perceived that their human rights had been infringed during acute episodes of illness. METHODS of containment were often seen as punitive rather than therapeutic. Sedation was most frequently used and was considered to be least distressing. Observing methods of forced/involuntary containment caused further distress. CONCLUSIONS There is a need to humanize service users' experiences during episodes of acute illness. Measures should include prevention of human rights abuses; minimization of isolation and distress; improvement of communication between service providers and service users; and promotion of attitudinal changes which reflect respect for other people's dignity.

UI	MeSH Term	Description	Entries
D007406	Interview, Psychological	A directed conversation aimed at eliciting information for psychiatric diagnosis, evaluation, treatment planning, etc. The interview may be conducted by a social worker or psychologist.	Interview, Psychologic,Interviews, Psychological,Psychological Interview,Psychological Interviews,Interviews, Psychologic,Psychologic Interview,Psychologic Interviews
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D010342	Patient Acceptance of Health Care	Patients' willingness to receive health care.	Acceptability of Health Care,Health Care Seeking Behavior,Acceptability of Healthcare,Acceptors of Health Care,Health Care Utilization,Nonacceptors of Health Care,Patient Acceptance of Healthcare,Care Acceptor, Health,Care Acceptors, Health,Care Nonacceptor, Health,Care Nonacceptors, Health,Health Care Acceptability,Health Care Acceptor,Health Care Acceptors,Health Care Nonacceptor,Health Care Nonacceptors,Healthcare Acceptabilities,Healthcare Acceptability,Healthcare Patient Acceptance,Healthcare Patient Acceptances,Utilization, Health Care
D010344	Patient Advocacy	Promotion and protection of the rights of patients, frequently through a legal process.	Patient Ombudsmen,Patient Representatives,Clinical Ombudsman,Patient Ombudsman,Advocacy, Patient,Ombudsman, Clinical,Ombudsman, Patient,Ombudsmen, Patient,Patient Representative,Representative, Patient,Representatives, Patient
D010356	Patient Isolation	The segregation of patients with communicable or other diseases for a specified time. Isolation may be strict, in which movement and social contacts are limited; modified, where an effort to control specified aspects of care is made in order to prevent cross infection; or reverse, where the patient is secluded in a controlled or germ-free environment in order to protect him or her from cross infection.	Home Isolation,Isolation, Home,Isolation, Patient,Negative Pressure Isolation,Negative Pressure Patient Isolation
D010865	Pilot Projects	Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work.	Pilot Studies,Pilot Study,Pilot Project,Project, Pilot,Projects, Pilot,Studies, Pilot,Study, Pilot
D011369	Professional-Patient Relations	Interactions between health personnel and patients.	Contacting Clients,Pharmacist-Patient Relations,Professional Patient Relationship,Client, Contacting,Clients, Contacting,Contacting Client,Pharmacist Patient Relations,Pharmacist-Patient Relation,Professional Patient Relations,Professional Patient Relationships,Professional-Patient Relation,Relation, Pharmacist-Patient,Relation, Professional-Patient,Relations, Pharmacist-Patient,Relations, Professional-Patient,Relationship, Professional Patient,Relationships, Professional Patient
D011618	Psychotic Disorders	Disorders in which there is a loss of ego boundaries or a gross impairment in reality testing with delusions or prominent hallucinations. (From DSM-IV, 1994)	Psychoses,Psychosis, Brief Reactive,Schizoaffective Disorder,Schizophreniform Disorders,Psychosis,Brief Reactive Psychoses,Brief Reactive Psychosis,Disorder, Psychotic,Disorder, Schizoaffective,Disorder, Schizophreniform,Disorders, Psychotic,Disorders, Schizoaffective,Disorders, Schizophreniform,Psychoses, Brief Reactive,Psychotic Disorder,Reactive Psychoses, Brief,Reactive Psychosis, Brief,Schizoaffective Disorders,Schizophreniform Disorder
D011678	Punishment	The application of an unpleasant stimulus or penalty for the purpose of eliminating or correcting undesirable behavior.	Punishments