Acceptability and use of coercive methods across differing service configurations with and without seclusion and/or psychiatric intensive care units

Aims To compare across different service configurations the acceptability of containment methods to acute ward staff and the speed of initiation of manual restraint. Background One of the primary remits of acute inpatient psychiatric care is the reduction of risks. Where risks are higher than normal, patients can be transferred to a psychiatric intensive care unit or placed in seclusion. The abolition or reduction of these two containment methods in some hospitals may trigger compensatory increases in other forms of containment which have potential risks. How staff manage risk without access to these facilities has not been systematically studied. Design The study applied a cross-sectional design. Methods Data were collected from 207 staff at eight hospital sites in England between 2013 - 2014. Participants completed two measures; the first assessing the acceptability of different forms of containment for disturbed behaviour and the second assessing decision making in relation to the need for manual restraint of an aggressive patient. Results In service configurations with access to seclusion, staff rated seclusion as more acceptable and reported greater use of it. Psychiatric intensive care unit acceptability and use were not associated with its provision. Where there was no access to seclusion, staff were slower to initiate restraint. There was no relationship between acceptability of manual restraint and its initiation. Conclusion Tolerance of higher risk before initiating restraint was evident in wards without seclusion units. Ease of access to psychiatric intensive care units makes little difference to restraint thresholds or judgements of containment acceptability.