Impact of a Program for the Management of Aggressive Behaviors on Seclusion and Restraint Use in Two High-Risk Units of a Mental Health Institute
The Omega Program for the Management of Aggressive Behaviors aims to reduce patients’ dangerous behaviors, towards themselves or others, and to reduce the use of seclusion and restraint (S/R). A previous study in a Mental Health Institute (Montreal, Canada) showed that implementing this program allowed employees of the intensive care and emergency units to gain confidence in coping with patients’ aggressions and to reduce their psychological distress. The present study, conducted in the same high-risk units, assesses the effect of the program on S/R use. We hypothesize that the incidence and duration of S/R should diminish significantly following the implementation of the program in both units. This naturalistic, prospective study covered archival data between April 2010 and July 2014. Pre-training data (April 2010–December 2011) were compared to data during training (January 2012–October 2012) and to post-training data (November 2012–July 2014) for both units. In the intensive care unit, we confirmed an increase of both mean daily number and duration of S/R by admissions in pre-training, followed by a decrease during the training and post-training. In the emergency unit, a decreasing trend is seen during the entire period thus suggesting that the decrease in S/R may be independent of the training. These findings suggest that Omega is a promising intervention program to use in an intensive care unit. However, a more global approach, including institutional changes in culture and attitude, can be important factors to develop to increase the positive outcomes.
KeywordsSeclusion Restraint Violence Psychiatric inpatients Intervention program De-escalation
The Canadian Institutes of Health Research, as well as the Mental Health Institute in which the study was conducted, had no authority over collection, management analysis and interpretation of data. The authors report no financial relationships with commercial interests. The authors are especially grateful to the staff of both units and to the management department, without whose efforts this study would not have been possible.
Compliance with Ethical Standards
This study was funded by the Canadian Institutes of Health Research.
Conflict of Interest
Steve Geoffrion declares that he has no conflict of interest. Jane Goncalves declares that she has no conflict of interest. Charles-Édouard Giguère declares he has no conflict of interest. Stéphane Guay declares he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics committee of the Institut Universitaire en Santé Mentale de Montréal (IUSMM).
Informed consent was obtained from all individual participants included in the study.
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