Restraint and seclusion practices in psychiatric inpatient hospitalization in Tanzania: Healthcare worker perspectives and implications for patient-centered care

Abstract

Restraint and seclusion (R/S) are used in psychiatric settings to manage aggression and agitation. Because these practices can cause psychological harm, physical injury and death, guidelines designate them as last-resort measures, yet their use frequently extends beyond psychiatric emergencies. In this study, we explored how R/S are understood, experienced and enacted within psychiatric care in Tanzania, focusing on their application, perceived impacts and future directions for training and intervention. We observed practices and conducted qualitative interviews with 20 doctors, nurses, clinical attendants and security guards involved in psychiatric care at a single Tanzanian hospital. We analyzed observational notes and data using applied thematic analysis. Seclusion rooms were used frequently and for extended periods. Physical restraint, such as physically holding patients or using bedsheets to cover their heads, was employed to facilitate chemical restraint or seclusion. While participants acknowledged physical restraint was potentially harmful, several expressed support for increasing chemical restraint and seclusion. Staff experienced a tension between their intentions to provide care and the potential for harm that was further compounded by the resource-limited context. To ensure patient safety and well-being, there is a need for safer, more humane standards and training in alternative aggression management techniques, including verbal de-escalation.