Impact of the physical environment of psychiatric wards on the use of seclusion
Open accessAbstract
Background: The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce. Aims: To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care. Method: Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses were used to explore the relationship with seclusion. Admission was the first level in the analyses and ward was the second level. Results: Overall, 14 design features had a significant effect on the risk of being secluded during admission. The ‘presence of an outdoor space’, 'special safety measures' and a large ‘number of patients in the building’ increased the risk of being secluded. Design features such as more ‘total private space per patient’, a higher ‘level of comfort’ and greater ‘visibility on the ward’, decreased the risk of being secluded. Conclusions: A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint.
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Die Häufigkeit der Anwendung von Isolationsmaßnahmen ist von bestimmten baulichen Gegebenheiten abhängig.
“Die Häufigkeit der Anwendung von Isolationsmaßnahmen ist ebenfalls von bestimmten baulichen Gegebenheiten abhängig (van der Schaaf, Dusseldorp, Keuning, Janssen & Noorthoorn, 2013).”
From Burg Lino – Ein innenarchitektonisches Konzept zur Verbesserung der stationären Behandlung in der Kinder- und Jugendpsychiatrie (2019) · cites this paper as van der Schaaf, Dusseldorp, Keuning, Janssen & Noorthoorn, 2013
The Multilevel analyses section reports that ward design features significantly affected the risk of a patient being secluded during admission. That supports an association with architectural features, but the Main findings section says the number of seclusions showed no significant effect. The claim’s wording about frequency therefore goes beyond the supported finding about risk. (LLM, conf=0.84)
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Cites
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Greenway, K. T., Garel, N., Jerome, L., & Feduccia, A. A. (2020) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2020.1772054 · Cited by 94 · see citing works
Aguilera-Serrano, C., Guzman-Parra, J., Garcia-Sanchez, J. A., Moreno-Küstner, B., & Mayoral-Cleries, F. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717738491 · Cited by 73 · see citing works
Wöckel, L., Rung, D., Bachmann, S., Dietschi, H., & Wild, D. (2019) · Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000641 · Cited by 5 · see citing works
- Authors
- van der Schaaf, P. S., Dusseldorp, E., Keuning, F. M., Janssen, W. A., & Noorthoorn, E. O.
- Affiliations
- Netherlands Organisation for Applied Scientific Research (NL)
- GGNet (NL)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2013-02
- Volume
- 202
- Issue
- 2
- Pages
- 142-149
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2066573625
- Cited by
- 127
- References
- 1
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 12 · 2023: 5 · 2022: 14 · 2021: 14 · 2020: 11 · 2019: 7 · 2018: 12 · 2017: 12 · 2016: 9 · 2015: 8 · 2014: 8 · 2013: 3
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- TNO Repository (submittedVersion)
- Repository hosted by TU Delft Library (TU Delft) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Ministerie van Volksgezondheid, Welzijn en Sport
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Keywords
- seclusion, physical environment, coercive measures, restraint, locked wards, aggression, outdoor space
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Aggression, Mental Disorders, Child, Coercion, Female, Forensic Psychiatry, Health Facility Environment, Hospitals, Psychiatric, Humans, Male, Middle Aged, Netherlands, Patient Isolation, Patients' Rooms, Restraint, Physical, Privacy, Principal Component Analysis, Multilevel Analysis, Young Adult, Patient Safety, Nursing Stations
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