Redecorating Hospitals Reduces the Use of Restraints and Seclusion by 82%

Rob Wipond
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Simple aesthetic improvements within psychiatric hospitals create massive reductions in the use of restraints and seclusion that are sustainable over the long term, according to a new ten-year follow-up study discussed in Psychiatric News.

“More than a decade ago, a team of mental health professionals initiated a study that would eventually show that an 82 percent reduction in a psychiatric hospital’s rates for seclusion and restraint use could be achieved within a relatively short time, simply by making the physical environment more aesthetically pleasing,” reports Psychiatric News. “Findings from that study showed that changes to the physical environment—such as repainting walls with warm colors, using decorative rugs, and restructuring furniture in common areas—were the only interventions associated with a significant drop in the rates of seclusion and restraint from the beginning of 2005 to mid-2008, whereas interventions such as increased trauma-informed training for hospital staff and shared decision making practices did not lead to a similar result.”

A co-author of the new ten-year follow-up study published in Psychiatric Services told Psychiatric News that the results continued even though the hospital underwent an administration shift during the time period under study. The team also observed that the more pleasing atmosphere seemed to make not just patients but also staff more calm. “The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice—even in the face of potentially disruptive administrative and environmental changes,” the researchers stated in their conclusions.

Psychiatric Hospital Aesthetics Affect Seclusion, Restraint Use (Psychiatric News, September 05, 2014. DOI: 10.1176/appi.pn.2014.9a5)

Efforts to Reduce Seclusion and Restraint Use in a State Psychiatric Hospital: A Ten-Year Perspective (Madan, Alok et al. Psychiatric Services 2014. DOI: 10.1176/appi.ps.201300383 )

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Rob Wipond
Rob Wipond is a Victoria, British Columbia-based freelance journalist who has been writing on mental health issues for fifteen years. His research has particularly focused on the interfaces between psychiatry, the justice system, and civil rights. His articles have been nominated for three Canadian National Magazine Awards, six Western Magazine Awards, and four Jack Webster Awards for journalism. He can be contacted through his website.

12 COMMENTS

  1. You say that keeping people in an environment resembling a concrete cage is not good for the general atmosphere? It should be enough to visit a old time zoo (fortunately they are disappearing more and more but there are still present in some places) in which animals are locked up in small cages with grits and concrete and nothing else. Just look at how they behave and if that look psychologically healthy to you. Yet psychiatry does the same thing with people and they get surprised to get a negative reaction. Stop locking people up, stop putting them in places that can make a happiest guy in the world suicidal in a day. But hey, they need studies for that and I bet it’s gonna get ignored anyway.

  2. This seems like absolute common sense- if you make the environment a bit nicer, people will act a bit nicer. But it seems to neglect real solutions at the same time, throwing out the idea of working with people in a compassionate and trauma-informed way in favor of an attitude of, “Let’s put down some nice throw rugs to make people forget we’ve locked them up for having committed no crime whatsoever.” Other than the obvious solution- not hospitalizing people against their will- trauma-informed care really does work when it’s properly implemented. A brief training will clearly not do the trick. Those outside “hospitals” must understand that these “emergency interventions” are used in clearly dire situations, like when my friend had an upsetting phone conversation and slammed the phone down very hard. She was in her eighties, had no history of violence, and, sensing the immediate reaction of the staff, put her hands in the air and continuously repeated that she was calm, but clearly, she posed an imminent threat and required restraint. Personally, I do not use violence, even in self-defense (more due to fear and multiple disabilities than anything else), but here’s the difference between a trauma-informed approach and psychiatry as usual. I was once hospitalized following a suicide attempt. I was on suicide watch for a couple of days, and became very upset when I was told that I could not take a shower without a staff member in the room. I began yelling at the staff who, instead of responding with fear of this “crazy” person screaming at them, understood that I have a sexual abuse history and found that concept to be very threatening. They gave me some space and promised me that nobody there was going to hurt me or look at me without my clothing on, and asked if we could sit down and come up with a solution that would work for everyone which, with the promise of safety, was accomplished quite easily. In contrast, a few years later, when I was being forcibly hospitalized for the crime of having a disease that an ER arbitrarily deemed “not real” (despite having been diagnosed by multiple, independent physicians), I was told I needed an EKG before I could be brought to the psych unit. I refused, citing the fact that a police officer had left the building only a few minutes before to discuss the sexual assault which had actually brought me to the ER in the first place and not wanting to remove any clothing, and was told that if I refused, I would be tied to the bed. I can absolutely see how someone in such a position could become violent. I really believe that the enormous distinction in how I was being treated was based on which psychiatric labels I had acquired- when I was only diagnosed with PTSD and depression, this seemed to make me a human deserving of respect, and when I was considered to have a delusional disorder, I was deserving of being treated with about as much respect as the nice, colorful walls and throw rugs that psychiatry is now aiming to patronize people with.

  3. ” I was told I needed an EKG before I could be brought to the psych unit. I refused”
    Interestingly, that same thing happened to me in a psych ward. I was supposed to lay down and get my EKG taken and I had no interest in it, don’t touch me (in an elevated voice). At this point the psychiatrist said “I have not time to deal with you, I have other patients”. I was dragged out of the room by several people, restraint suffering physical injuries and forced drugged. Sounds like a reasonable response. I wonder why I threw chairs at them when they untied me next time around (allegedly – I don’t remember anything since they drugged me with benzos and they cause among others anterograde amnesia).
    Yeah, the whole trauma informed training is bs in most cases, they sit through a few hours of talk and then go back to business as usual. If you give people power to abuse others they will abuse them no matter what training you provide. Abolish forced psychiatry and inject some accountability into the system – then maybe something will change.

    • I fainted when the psychiatrist said that the EEG revealed that I had permanent irreversible brain damage. It was suspected that I had temporal lobe epilepsy so I was confined in the van and escorted to a medical hospital for a CAT scan. I was very reluctant to go through with the procedure. I am somewhat clausterphobic. The technician coaxed me through it, but was not really abusive. I have wondered what would have happened had I refused to cooperate. It seems that the have us cornered, at least for the time being when it comes to involuntary commitment, but don’t we all have the right to refuse medical treatment. Isn’t the radiation exposure from these test cumulative?

      • Yes it is. It’s still considered safe but the truth is any X-ray exposure adds up to the danger of developing cancer. It’s ridiculous that when you’re a “normal” patient you can refuse any, especially invasive, medical test but as soon as you get a label they can do whatever the heck they want.