Special Section on Seclusion and Restraint: Consumers' Perceptions of Negative Experiences and "Sanctuary Harm" in Psychiatric Settings

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
Psychiatric Services (Impact Factor: 2.41). 10/2005; 56(9):1134-8. DOI: 10.1176/
Source: PubMed


Recent studies show a high prevalence of trauma symptoms among people with serious mental illness who are treated in public-sector mental health systems. Unfortunately, growing evidence suggests that many consumers have had traumatic or harmful experiences while being treated in various psychiatric settings. This study explores consumers' perceptions of such harmful inpatient experiences, events that the authors place under the rubric of "sanctuary harm."
The authors conducted semistructured qualitative interviews with 27 randomly selected mental health consumers to hear their descriptions of adverse events that they experienced while receiving psychiatric care. Our analysis of interview transcriptions focused on understanding consumers' narratives of harmful experiences-events that would not meet DSM-IV criteria for trauma but that nevertheless resulted in significant distress.
Eighteen of 27 interviewees described harmful incidents that they had witnessed or experienced directly, many of which evoked strong emotional responses by consumers during their narration. Nearly all incidents described were hospital based and were clustered around two sets of themes. The first set related to the hospital setting, including the fear of physical violence and the arbitrary nature of the rules. The second set related to the narrators' interactions with clinical staff, including depersonalization, lack of fairness, and disrespect.
The findings suggest that many mental health consumers have had a lifetime sanctuary experience that they perceived as harmful. They also offered suggestions for how the mental health service delivery system might reduce the potential for sanctuary harm experiences.

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    • "As multidisciplinary teams of psychiatrists , nurses and social workers provide (if necessary) unsolicited assistance, are available seven days a week and 24 hours a day and share clients in their caseload, it is the assumption that latent crises are easier to be detected and consequently coercive measures can be averted (McAdam & Wright 2005, Sytema et al. 2007, Mancini et al. 2009, Marshall & Lockwood 2010). Averting coercion with this target group is a major benefit, as consequently the accumulation of negative experiences with professional care will be halted (Forchuk & Reynolds 2001, O'Brien & Golding 2003, Bertram & Stickley 2005, Frueh et al. 2005, Robins et al. 2005, Katsakou et al. 2010, Landeweer et al. 2011, Voskes et al. 2013). However, as caseloads are extensive and negatively impacted by administrative pressures, professionals can spend little time per client (Salyers & Bond 2001, Macleod et al. 2011), resulting in what Simpson (2005, p. 695) calls 'limited nursing'. "
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    ABSTRACT: To understand whether and how Family Group Conferencing might contribute to the social embedding of clients with mental illness. Ensuring the social integration of psychiatric clients is a key aspect of community mental health nursing. Family Group Conferencing has potency to create conditions for clients' social embedding and subsequently can prevent coercive measures. A naturalistic qualitative case study on the process of one conference that was part of 41 conferences that had been organized and studied from January 2011-September 2013 in a public mental health care setting in the north of the Netherlands. Semi-structured interviews (N = 20) were conducted with four stakeholder groups (N = 13) involved in a conference on liveability problems in a local neighbourhood wherein a man with schizophrenia resides. To prevent an involuntary admission to a psychiatric ward of a man with schizophrenia, neighbourhood residents requested a family group conference between themselves, the sister of the man and the mental health organization. As a possible conference aggravated psychotic problems, it was decided to organize it without the client. Nine months after the conference, liveability problems in the neighbourhood had been reduced and coercive measures adverted. The conference strengthened the community and resulted in a plan countering liveability problems. The case indicates that social embedding of clients with severe psychiatric problems can be strengthened by Family Group Conferencing and that hence coercive measures can be prevented. A shift is required from working with the individual client to a community driven approach.
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    • "In addition, consumers surveyed about their experiences in behavioral healthcare settings reported violence and fear of violence (including seclusion and restraint), as well as negative interactions with staff and feelings of being disrespected. These experiences have been called " sanctuary harm " (Robins et al. 2005). Clients who have been traumatized enter our agencies upset and fearful of being hurt and betrayed by providers. "
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    ABSTRACT: Clients in substance abuse treatment need, in addition to evidence-based and sensitive treatment services in general, a system of care that takes into account the impact of trauma and violence in so many of their lives. In addition, services need to be delivered in a way that avoids triggering trauma memories or causing unintentional re-traumatization. To that end, this article describes an agency self-assessment process that combines a trauma-informed assessment, a NIATx process of "walking-through" and use of the Institute of Healthcare Improvement's Plan-Do-Study-Act (PDSA) cycles, and a user-friendly format. The trauma-informed assessment is designed to address issues of safety of clients and staff members, reduction of re-traumatization, consistency in practice, and client empowerment. It brings a non-judgmental, collaborative approach to process and practice improvement. The article describes how the assessment process can be--and has been--used to develop an Action Plan, including trainings and the identification of "trauma champions"; i.e., staff who will continue to spread trauma-informed changes and new evidence-based practices throughout the agency. As we enter a period of healthcare reform, addressing trauma as an integral part of addiction treatment also allows us to better deal with the totality of our clients' health problems.
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    • "Psychiatric research noted the importance of how staff meets patients; disrespectful and humiliating ways are not part of patient safety (Frueh et al. 2005, Robins et al. 2005). Staff's loyalty to the procedures, guidelines, and decisions taken also has an impact (Robins et al. 2005). "
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    ABSTRACT: Patient safety is widely discussed, but little has been written from the perspective of psychiatric inpatient care, nor on which factors create its patient safety. This paper seeks to understand the concept of patient safety and its intension in psychiatric inpatient care, and to identify factors in organization management, staff and patients' roles which constitute patient safety in such units. A literature search was conducted, and the articles selected were analysed by identifying factors defined to be connected to patient safety and classifying them according to their connection to organization management, staff and patient roles. According to the literature, organization safety culture is present in all aspects of patient safety. Organization management has the main role in patient safety within the organization culture, for example, through leadership, safety practices and creating good working conditions and environment for the staff. Staff's role is influenced by management, but has more individual input in different areas, while the patient's role is more that of an informant so that care can be planned according to the patient's preferences. When developing patient safety it is important to remember the diversity of the concept so that all areas are considered in the developmental work.
    Full-text · Article · Jul 2012 · Journal of Psychiatric and Mental Health Nursing
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