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Innovation and pragmatism required to reduce seclusion practices

机译：减少隐居实践所需的创新和实用主义

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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.
机译：隐居可能对患者有害和创伤，对治疗关系有害，并且可能导致员工身体伤害。此外，减少隔离的策略已被确定为提高精神经理服务成本效益的潜在方法。但是，开发隐居的替代策略可能是困难的。减少隐居的干预措施不会使用随机对照试验（RCT）来评估，尽管综合文学评论已经表现出可相当大的非RCT证据，但干预措施，以减少精神病设施中的隐居。在英国，在高安全英国医院中最近对隐居实践进行了5年的评价，揭示了减少的隐居率而不会增加不利事件。为了评估新的干预策略对英国高度依赖性法医法医精神病病房减少长期隔离的影响，我们介绍了一个涉及分层的隐居水平的试点计划（“长期隔离”），多学科反馈和信息共享以及定制职业治疗计划。证明了降低的隐居，员工反馈主要是积极的，表明病房的活力增加和赋予权力。一种更具结构化的，分层的隐私方法，包括多学科团队工作，高级行政参与，动态风险评估，以及定制职业治疗可能导致更有效的降低高安全医院和其他精神病环境的分辨率。虽然缺乏RCT水平的证据基础，但创新的务实策略可能会对临床水平产生影响，并且应该引导未来的实践和研究。

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