Have we lost the thread? Restraint and seclusion in emergency departments

The use of physical restraint and seclusion by mental health professionals has received increased scrutiny, with Australian and international initiatives to reduce it. These practices have not been extensively studied in emergency departments (EDs) until now. EDs are unique settings with challenges for both mental health professionals and consumers, such as the need to form relationships in a short time, and changes to mental health services leading to consumers in crisis needing to present at the ED. This study investigated the use of physical restraint (hands-on immobilisation and mechanical restraint) and seclusion in EDs over one-year. Retrospective data was collected from three departments in metropolitan Australia, and numbers of consumers restrained or secluded were examined. Analysis revealed 58 recorded incidents involving mechanical restraint, nine involving physical restraint and nine involving seclusion. In some cases, more than one method of restraint was used. 39 males and 28 females were restrained or secluded. While more than one reason for the use of these containment methods was often recorded, prevention of harm to self was recorded with the highest frequency. Almost 90% of consumers restrained had a diagnosis of mental illness. There was a median duration of restraint/seclusion use of 140 minutes, although there was wide variation. Shackles were most often used in mechanical restraint. One ED was responsible for almost 50% of restraint/seclusion events. The need for sustained examination of restraint and seclusion use, the experience of the consumer and education of mental health staff is explicated to guide future practice.