Shankar Chakkera, Julia Sieg, Theodora Khofi, Rosemina Ayieko, Brandon A Knettel
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The management of psychiatric emergencies in Africa: A scoping review of restraint and seclusion practices in clinical settings and their impacts.
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.
期刊介绍:
lobal Mental Health (GMH) is an Open Access journal that publishes papers that have a broad application of ‘the global point of view’ of mental health issues. The field of ‘global mental health’ is still emerging, reflecting a movement of advocacy and associated research driven by an agenda to remedy longstanding treatment gaps and disparities in care, access, and capacity. But these efforts and goals are also driving a potential reframing of knowledge in powerful ways, and positioning a new disciplinary approach to mental health. GMH seeks to cultivate and grow this emerging distinct discipline of ‘global mental health’, and the new knowledge and paradigms that should come from it.