The management of psychiatric emergencies in Africa: A scoping review of restraint and seclusion practices in clinical settings and their impacts.

Abstract

More than 116 million people in Africa live with mental health conditions. However, many African countries lack the infrastructure, training and workforce to effectively manage psychiatric emergencies. This has led to overuse of controversial practices such as physical and chemical restraint and involuntary seclusion, often violating patient rights. We conducted a scoping review of restraint and seclusion practices and their impacts in African clinical settings using the PubMed, Embase, CINAHL, PsycInfo and ProQuest databases. Titles/abstracts and full texts were reviewed for inclusion using the Covidence platform, and 29 studies were included in the final extraction. Restraint and/or seclusion were employed to manage aggression, enable involuntary treatment or prevent self-harm. Patients found restraint and seclusion to be dehumanizing, a cause of posttraumatic stress and a barrier to future help-seeking. Healthcare workers described inadequate training, overuse of restraint and seclusion, injuries and emotional distress after employing these treatments. Further research, intervention development and policy reform are urgently needed to promote humane and patient-centered psychiatric care, including verbal de-escalation training, in underresourced healthcare systems.