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There are substantial regional differences in the use of coercive measures in mental health in Norway. The Norwegian Directorate of Health is working with a national standardized package of procedures for improving and reducing use of coercion in mental health care and commissioned an updated systematic review to support this work. We summarized 21 studies about interventions for reducing seclusion and restraint in mental health care for adults. The report is an update of a previous systematic review on the same topic conducted in 2012. We included eight new studies in the updated report. Main findings:1. Joint crisis plans probably reduce the number of compulsory admissions.2. Systematic evaluation of aggressive behaviour in patients admitted to an acute psychiatric ward, may reduce the use of restraint and seclusion.3. Couselling towards staff in high security wards may reduce seclusion and restraint.4. For the other interventions (such as community-care network, involuntary outpatient commitment program and personal advocacy for inpatients) conclusions could not be drawn. Further research is needed in order to draw more robust conclusions about the effect of interventions intended to reduce coercive measures, seclusion and restraint, in mental health services. We included 21 studies, of which two were conducted in Norway. All included studies, examined the effect of interventions that are used in Norway, for example joint crisis plans, risk assessment, Assertive Community Treatment teams (ACT-teams), crisis resolution teams and use of written patient contracts.

Coercion. --- Isolation (Hospital care)

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In Norway there are substantial regional differences in the use of coercive measures in mental health care. There is also variation in use of coercion between mental health care institutions. At present Norwegian authorities are revising an Action Plan from 2006, aiming to reduce the use of coercion and to improve the quality of mental health services when coersive measures are used in accordance with the mental health act. In this systematic review interventions intended to reduce the use of coercive measures in mental health services for adults have been examined. Main findings:1. Joint crisis plans may reduce the number of compulsory admissions, but the documentation was of low quality.2. Systematic evaluation of aggressive behaviour in patients admitted to an acute psychiatric ward, may reduce the use of restraint and seclusion, but the documentation was of low quality.3. For the other interventions conclusions could not be drawn. Further research is needed in order to draw more robust conclusions about the effect of interventions intended to reduce coercive measures, seclusion and restraint, in mental health servies for adults. We included 12 studies. None of the included studies were conducted in Norway. However, the studies examined the effect of interventions that are used in Norway, such as joint crisis plans, risk assessment, Assertive Community Treatment teams (ACT-teams), crisis resolution teams, and use of written patient contracts, such as booklets containing treatment options.

Isolation (Hospital care) --- Medical policy.

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Hygiene. Public health. Protection --- Hospital buildings --- Isolation (Hospital care) --- Nosocomial infections --- Hôpitaux --- Isolement (Soins hospitaliers) --- Infections nosocomiales --- Sanitation --- Hygiène --- Hôpitaux --- Hygiène --- 614.45 + 64.024.8 + 725.51

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Social isolation --- Segregation --- Imprisonment --- Exile (Punishment) --- Mentally ill --- Isolation (Hospital care) --- Institutional care --- Isolement social --- Ségrégation --- Emprisonnement --- Bannissement --- Internement (Psychiatrie) --- Isolement (Soins hospitaliers) --- Soins en institutions --- History. --- Commitment and detention --- History --- Histoire --- Social Isolation. --- Cross-cultural comparison. --- Institutionalization --- Prisons --- Vulnerable Populations. --- history. --- Ségrégation

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Isolation (Hospital care) --- Restraint of patients --- Psychiatric hospital patients --- Civil rights --- Involuntary treatment --- Isolement (Soins hospitaliers) --- Contention (Soins hospitaliers) --- Patients des hôpitaux psychiatriques --- Droits de l'homme --- Traitement non volontaire (Thérapeutique) --- Law and legislation --- Law and legislation --- Legal status, laws, etc. --- Law and legislation --- Droit --- Droit --- Droit --- Droit