We recently showed that restraint and seclusion differed in children and adolescents (n = 2411) who were receiving treatment as psychiatric inpatients, with children experiencing more episodes of both of these interventions of shorter duration. In this report, we examine restraint and seclusion in members of that sample (n = 471) who experienced a readmission within two years.

The initial database included two years of data on a total of 2411 child and adolescent inpatients, with 20% being readmitted within that period. Statistical analyses examine the characteristics of the sample at the readmission, including correlations between satisfaction with treatment at discharge from the readmission and the comparisons of the frequency of restraint and seclusion at both admissions. These analyses were performed separately for the samples of children and adolescents.

In the cases who experienced restraint or seclusion at their first admission there was a 22% reduction in occurrence of restraint at the second admission for children and 44% for adolescents. Comparisons of the patients who did and did not experience restraint and seclusion across admissions suggested that these are different populations with different overall risk for restraint seclusions. Risk for seclusion and the number of seclusions was correlated across admissions. Length of stay was shorter at readmission for patients who experienced seclusion or restraint during their first admission. Patients who experienced restraint or seclusion at their readmission did not differ in their satisfaction with treatment at discharge from their readmission from those who did not.

Children and adolescents who experienced restraint and seclusion during a psychiatric admission had a reduced risk of seclusion at a readmission, but were still at higher risk than cases without restraint and seclusion at the first admission. These reductions in risk, as well as a shorter length of stay at readmission, suggest potentially beneficial effects. The lack of increased dissatisfaction with treatment also indicates that these cases did not see themselves as excessively coerced or victimised by the experience. Nonetheless, the high rate of occurrence of restraint and seclusion suggests that alternative treatment interventions are clearly important.

Assaults on staff on psychiatric intensive care wards are unfortunately common and have a negative impact on morale.

Staff on one PICU completed a survey providing an account of any assaults they had experienced over the previous year and a separate survey regarding attitudes towards assaults.

65% of staff members reported having being assaulted over the year. Most did not take any time off work. Attitudes towards prosecution of patients varied. Staff valued training in this area.

Assaults are common on a PICU and staff are ambivalent about prosecuting patients. More training may be of value regarding prediction of assaults, and about the criminal justice interface.

Patient emotion, behaviour, and symptoms may explain avoidance of the daily programming on an acute psychiatric inpatient treatment milieu. We compared changes of emotion, behaviour, and symptoms among acutely ill psychiatric inpatients assigned to Behavioural Activation Communication (BAC), a newly designed milieu program, and those assigned to a unit representing treatment as usual (TAU).

Participants included 144 adult inpatients treated between January 2011 and July 2011 at two similar psychiatric units at a medical centre. Psychiatric patients were assigned to either the BAC or the TAU unit based bed availability. At admission and discharge, patients completed the Brief Symptom Inventory, Positive Affect and Negative Affect Scale, and the Checklist of Unit Behaviors.

A comparison of BAC and TAU patients showed greater relative change on positive affect and of behavioural activation with the daily programming.

The BAC program is associated with a significant increase of positive emotion and activation of inpatients.