Seclusion should always be the last resort when it comes to dealing with aggressive episodes involving young offenders with psychiatric disorders, according to staff who took part in a four-country study published in the November issue of the Journal of Psychiatric and Mental Health Nursing.
Researchers led by the Universities of Turku and Tampere, Finland, report that the multi-disciplinary teams they spoke to said that verbal intervention was their first choice. Putting adolescents in a bare, locked room was viewed as the least favoured option in the three countries where seclusion remains legal.
The research team also found that countries with a longer history of treating adolescents in medium to high security units tended to use less physical restraints on fewer occasions.
"Adolescent aggressive behaviour poses a challenge for staff working in forensic units, which cater for 12 to 18 year-olds who have been in trouble with the law, because it occurs so frequently" says lead author Johanna Berg from the Department of Nursing Science at the University of Turku.
"Our study of units in Belgium, Finland, the Netherlands and UK found that while the principles of dealing with aggression were fairly similar, there were some differences in the practical solutions."
The study comprised forensic units ranging from eight to 12 beds, treating young offenders with a range of problems, including: severe mental health disorders, delinquent, violent and non-compliant behaviour and impulse control problems. One unit was established in the 1980s (UK), two in the 1990s (Belgium and the Netherlands) and one in the 2000s (Finland).
The 58 staff, including nurses, doctors, psychologists, social workers, educators, support workers, occupational, art and family therapists and sports instructors, had an average age of 36.
Key findings from the one-to-one interviews included:
"Staff in all four units displayed high ethical standards when it came to the use of restrictive treatment measures" says Johanna Berg. "They endeavoured to cooperate with the adolescent as long as possible and avoid coercive measures, while still maintaining the safety of others."
The research team have come up with a number of key recommendations for clinical practice as a result of their research:
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