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Cited by 5Healthcare Decision-Making and RestraintsElectroconvulsive Therapy StudiesRestraint-Related Deaths

Seclusion, Restraint, Therapeutic Alliance, and Legal Admission Status: What Really Matters?

O’Callaghan, Aoife K., Plunkett, Róisín, Kelly, Brendan D.·2022·Journal of Psychiatric Practice
DOI 10.1097/pra.0000000000000665
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Abstract

Objective: To determine the relationships, if any, between use of seclusion and restraint and factors such as demographic parameters, diagnosis, legal admission status (voluntary or involuntary), symptoms, cognitive function, global functioning, therapeutic alliance, attitudes toward medication, and insight, among psychiatry inpatients in Ireland. Methods: We used validated tools to perform detailed assessments of 107 adult psychiatry inpatients admitted to acute psychiatry units at 2 general hospitals in Dublin, Ireland over a 30-month period, between September 2017 and February 2020. Results: The most common diagnoses in our sample were affective disorders (46.7%), schizophrenia and related disorders (27.1%), and personality and behavioral disorders (11.2%). Over a quarter (n=29, 27.1%) of the participating patients had involuntary legal status. Of the 107 patients, 11 patients (10.3%) experienced sedation and/or physical restraint, with 9 patients (8.4%) experiencing at least 1 episode of seclusion and 10 patients (9.3%) experiencing at least 1 episode of physical restraint. On the basis of multivariable analyses, seclusion was associated with younger age and involuntary status, while physical restraint was associated with involuntary status. Each multivariable model explained just over one third of the variance in the distribution of these seclusion and restraint practices. Conclusions: Use of seclusion and restraint was most strongly associated with involuntary admission status and, in the case of seclusion, younger age, rather than sex, diagnosis, symptoms, cognitive function, global functioning, therapeutic alliance, attitudes toward medication, or insight. The network of interactions between involuntary status and use of seclusion and restraint merits much closer attention, especially as use of seclusion and physical restraint appears to be associated with involuntary legal status independent of level of symptoms, therapeutic alliance, or insight.

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  • Once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis.

    “A similar cycle of coercive care provision may also be evident during admission, with the available literature indicating that once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis (34,76–88), and may be more likely to display aggressive behaviours (”

    From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [82]

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Authors
O’Callaghan, A. K., Plunkett, R., & Kelly, B. D.
Affiliations
  • Tallaght University Hospital (IE)
  • National Maternity Hospital (IE)
Corresponding author
O’Callaghan, Aoife K.
ORCID
Venue
Journal of Psychiatric Practice
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-11
Volume
28
Issue
6
Pages
454-464
ISSN
  • 1527-4160 (ISSN-L)
  • 1538-1145
DOI
10.1097/pra.0000000000000665
OpenAlex
W4308885754
Cited by
5
References
32
Citations by year
2025: 1 · 2024: 2 · 2023: 2
FWCI
1.14
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Psychiatric Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
Keywords
seclusion, physical restraint, involuntary admission, therapeutic relationship, psychiatric inpatients, mood disorders, schizophrenia, attitudes toward medication, insight, sedation
MeSH terms
Therapeutic Alliance, Adult, Mental Disorders, Hospitalization, Hospitals, Psychiatric, Humans, Patient Isolation, Restraint, Physical

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