Does ending night-confinement reduce use of seclusion and prevalence of violence in a forensic psychiatric hospital? A retrospective observational study.

Dr Rosemary Williams1, Dr Owen Haeney2,3,4

1Central Adelaide Local Health Network, Adelaide, Australia, 2Forensic Mental Health Service, Northern Adelaide Local Health Network, Northern Adelaide , Australia, 3The University of Adelaide, Adelaide, Australia, 4School of Psychiatry, University of New South Wales, Sydney, Australia

Forensic mental health services strive to balance the necessary use of restrictive practices to maintain safety with creation of a therapeutic environment. There is currently limited research into the effects of least restrictive policies on forensic ward environments. The present retrospective observational study looks at a forensic mental health facility in South Australia and reviews the incidents of seclusion, restraint, and violence both one year before (2018) and one year after (2019), the introduction of a policy which ended night-confinement and allowed patients to exit their rooms overnight. All incidents of seclusion, restraint and violence during 2018 and 2019 were analysed using cross tabulations, and a linear regression model for seclusion hours. The results show that there were fewer episodes of seclusion in 2019 compared with 2018 but significantly greater mean hours spent in seclusion by patients in 2019 than 2018. There was an increase in the use of chemical restraint in 2019, however there was no statistically significant difference in incidents of violence or in the use of physical restraint. While the research is of a small scale, it does suggest that policies ending night-confinement do not lead to increased seclusion episodes and encourages future research in this area.


Biography:

Dr Rosemary Williams is a psychiatry registrar working in Adelaide. She has spent time working in South Australia’s forensic hospital James Nash House, and has an interest in pursuing an advanced certificate in forensics.