[The Model of Prevention of Seclusion and Restraint Use in Mental Health: An Integrative Review].

Abstract

Background Seclusion and restraint are still being used frequently in psychiatric and mental health care despite their known harmful effects. Many countries have the goal of reducing their use, leading to a number of research on prevention interventions. While many of these interventions have been shown to be effective, reducing restrictive practices depends on several factors. Conceptual models have been developed in relation to seclusion and restraint, but none have addressed their prevention specifically. Aim This article aims to propose The Model of prevention of seclusion and restraint use in mental health by carrying an integrative review on the subject. Methods An integrative review was conducted using Whittemore et Knafl's (2005) approach. Four databases (Pubmed, PsycINFO, EMBASE, CINAHL) were searched for publications between 2010 and 2020, in French or English. Search terms included seclusion, restraint, psychiatr*, mental health reduction and mental health prevent*. The search resulted in the inclusion of 138 articles. Data was analyzed using thematic analysis (Miles et coll., 2014) and categorized with Bronfenbrenner's (1979) ecological model. Results The six categories represented in the ecological model are described in terms of systems mutually involved in the prevention of seclusion and restraint use: the person (individual), the professionals and the physical environment (microsystem), the ward culture (mesosystem), organizational initiatives (exosystem), national policies and international organizations (macrosystem) and evolution of the discourse or resistance to change (chronosystem). Specific interventions are presented for each system, as well as their interactions. Conclusion The prevention of seclusion and restraint use in mental health is a shared responsibility between the systems involved, who must act as leaders and agents of change by implementing their specific activities. Preventing restrictive practices in mental health will be achieved by developing a shared responsibility and a shift towards a culture of partnership.