Seclusion & Restraint - Rediscovering Pathways to Compassionate Care

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For Full Article: http://www.aacap.org/cs/root/member_information/practice_information/jan/feb_2006_aacap_news_seclusion_restraint_rediscovering_pathways_to_compassionate_care

Now, sensory interventions and alternative environments to create sanctuary on inpatient units are emerging in U.S. psychiatric inpatient facilities. Specifically, occupational therapy practices are being more fully integrated into treatment strategies, crisis prevention plans and focal skill development for consumers and staff. Sensory assessments of individual “sensory diets” to determine whether someone is sensoryseeking or sensory-avoiding are providing important information for developing individualized repertoires of interventions designed to teach self-soothing and self-calming skills. Likewise, established nursing methods such as aromatherapy and therapeutic touch are also being used, including arm and hand massages, medicine ball massages, and the use of vibration.11 Historically (and currently) psychiatric inpatient settings had quiet rooms. Quiet rooms were paradoxically named “sensory-stripped rooms,” and were intended to promote quiet and restore calm. Unfortunately, they seldom did. Now, hospitals are replacing quiet rooms with attractive sensory rooms for people in treatment to learn what helps to calm them and what does not. For example, in Massachusetts, at Taunton State Hospital, a modest Snoezelen room was created for adolescents to learn about sensory preferences, how to assess their own response to stimulating and relaxing exercises and develop new self-calming skills. Snoezelen technology originated in Holland more than 35 years ago when sensory interventions were recognized as having therapeutic benefit for people with different types of impairment.12 Similarly, Cohannet Academy, another adolescent program at Taunton, developed a sensory room named “The Getaway” and linked sensory interventions to the adolescent’s emotional and behavioral regulation skill development used as part of the program’s overall dialectical behavior therapy orientation. These on-unit room conversions incur a fraction of the cost of restraint room equipment. The Getaway was created through donations from the community and staff ingenuity. Moreover, converted sensory rooms create a pleasant, relaxing environment and remove visible, aversive stimuli from settings intended for healing and care.

Other rooms, such as comfort rooms, are also being created in psychiatric hospitals throughout the country. Comfort rooms reflect the experience of South Florida State Hospital and the expertise of Gayle Bluebird, RN, a consumer advocate who created and implemented comfort rooms to provide an on-unit haven and tool to help prevent the use of restraint and seclusion.10 Comfort rooms conceptually differ somewhat from sensory rooms in that there is no sensory experimentation or stimulation. Comfort rooms are designed with consumers and for consumers and intended to be a place to relax and restore.

It appears that history is repeating itself. The coercive treatment tide seems be turning once again. As efforts to eliminate violence from treatment settings continue, there is increased recognition of the importance of attending to sensory needs, what Conolly called “securing a sound mind in a sound body.” Similarly, as restraint and seclusion are removed from intervention repertoires, the importance of creating restorative sensory alternatives—likely not too dissimilar from Tuke’s “Retreat”—is being recognized. The imperative for all treatment practitioners is to transmit these lessons learned, interrupt the cycle of intervention amnesia, and perpetually hold the perspective of those we serve as our treatment compass.