The use of containment methods in acute mental health wards: A literature review

Ιn acute psychiatric wards, containment measures are applied to ensure safety and to avoid harm. However, containment limits the autonomy of people with mental health problems.

Aim: The presentation of a) the reasons for the use of containment in psychiatric clinics, b) the attitudes of mental health professionals and people with mental health problems about the containment methods, c) the effect of coercion on the therapeutic effect, as well as d) the strategies to reduce containment and to create a positive ward atmosphere.

Material and method: A literature review containing studies published from 01/01/2000 to 31/01/2022 in English and Greek language, in the PubMed and Cochrane Library databases was conducted. The following keywords were used:coercion", “containment”, “involuntary”, “acute psychiatry”, “restraint”. “seclusion”, “mental health”, “attitudes”. Exclusion criteria were the language (expect for English and Greek) and the type of article (letter to the publisher, editorial article, and case study).

Results: 41 studies were included in the review. Psychomotor anxiety, disorientation and subsequently, violence are the most common reasons for the use of coercion. Involuntary hospitalization, male gender, diagnosis of schizophrenia and substance use are associated with more frequent use of containment methods. Intercultural and interdepartmental differences concerning the use of containment methods are reported. The attitudes of mental health professionals have shifted from a therapeutic paradigm (restrictive measures are therapeutic) to a safety paradigm (restrictive measures are a necessary evil). The use of coercion impedes the therapeutic relationship. In Greece, high rates of involuntary hospitalization and mechanical restraint are reported. The ward atmosphere is related to the extent of the use of coercion. Multifactorial approaches are needed to create a therapeutic environment and reduce coercion.

Conclusions: The use of containment may traumatize both people receiving mental health care and mental health professionals. The implementation of alternative interventions to create a therapeutic environment requires the appropriate training of the staff, but mainly the adequate staffing of the psychiatric departments.

Keywords:   psychological  interactions